Safe and Accurate Sustentaculum Screw Placement in Minimally Invasive Surgery for Calcaneal Fractures: The “Sustentaculum View” Technique

Background: The sustentaculum screw plays a crucial role in achieving stable osteosynthesis for intra-articular calcaneal fractures, particularly when using minimally invasive or percutaneous techniques. Accurate placement of the screw within the sustentaculum tali is technically demanding due to the complex anatomy and the limited intraoperative visualization provided by standard fluoroscopic views. Methods: Patients were positioned in a standardized lateral decubitus position. Beginning with a standard lateral fluoroscopic view, the C-arm was tilted approximately 25° to align the central beam with the plane of the lower ankle joint. This adjustment enables clear visualization of the borders of the sustentaculum tali and allows precise definition of the target point for guide-wire insertion. To evaluate whether this technique improves screw positioning, two groups were compared: one using the described fluoroscopic view and a control group using conventional imaging alone. Results: Screw placement accuracy was significantly higher in the group using the dedicated fluoroscopic view compared with the control group. Conclusions: With meticulous preoperative planning, standardized positioning, and the use of a dedicated fluoroscopic setting—referred to as the “sustentaculum view”—accurate and safe screw placement can be achieved with significantly higher accuracy than with conventional imaging alone.