Clinical application of robot-assisted fixation for calcaneal fractures: a meta-analysis with subgroup comparisons
In brief
Robot-assisted calcaneal fixation cuts complications by roughly four-fifths
In a meta-analysis of 14 studies with 812 patients, robot-guided percutaneous screw fixation lowered intra-operative blood loss by about 30 ml, shortened incisions by 6 cm, reduced hospital stay by three days, and decreased overall complication risk to about one-fifth of conventional surgery, while improving pain and functional scores. Operative time was modestly longer and long-term outcomes remain under-reported.
- Journal
- Journal of robotic surgery (Q1)
- Published
- 11 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Zhen Yang, Yupei Dai, Ruoyan Wang, Ran Ji, Lijing Si, Jie Zhao, et al.
- PMID
- 42579176
- DOI
- 10.1007/s11701-026-03788-6
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 16 August 2026): Robot‑assisted fixation improves calcaneal fracture outcomes
- Picked for Orthopedics and Sports Medicine (top studies of the week, 16 August 2026).
Abstract
Robot-assisted percutaneous cannulated screw fixation is an emerging minimally invasive technique for calcaneal fractures; however, its comparative effectiveness remains uncertain. This systematic review and meta-analysis evaluated perioperative outcomes, radiographic restoration, functional recovery, and complications associated with robot-assisted fixation. PubMed, Embase, Cochrane Library, Web of Science, and CNKI were searched from inception to April 2026. Controlled studies comparing robot-assisted and conventional fixation were included. Two reviewers independently performed study selection, data extraction, and quality assessment. Meta-analyses and subgroup analyses according to robotic platforms (TiRobot, Holosight, and unspecified systems) were conducted using Review Manager 5.4. Fourteen studies involving 812 patients (401 robot-assisted and 411 conventional cases), including two randomized controlled trials and twelve non-randomized studies, were included. Compared with conventional fixation, robot-assisted procedures reduced intraoperative blood loss (MD = - 28.65), incision length (MD = - 5.70), hospital stay (MD = - 3.38), guidewire adjustments (MD = - 2.17), and fluoroscopy exposure (MD = - 4.81). Robot-assisted fixation improved calcaneal morphological restoration and Gissane angle, while Böhler angle improvement was mainly observed in the TiRobot subgroup. It also shortened fracture healing time (MD = - 1.21), reduced pain scores (MD = - 0.92), increased AOFAS scores (MD = 5.33), and decreased overall complications (OR = 0.18). Operative time was slightly prolonged, particularly in the TiRobot subgroup. Robot-assisted fixation may provide short-term benefits in perioperative recovery, anatomical restoration, functional outcomes, and complication reduction for calcaneal fractures. TiRobot has the largest evidence base and demonstrated relatively consistent favorable outcomes; however, its superiority over other robotic platforms remains unconfirmed due to limited comparative evidence. Current evidence is mainly derived from Chinese cohorts with limited follow-up, and long-term functional and economic outcomes remain insufficiently reported. Further international multicenter studies with longer follow-up are warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.