The Impact of Surgical Timing and Surgical Approach on Outcomes Following Calcaneal Fractures: A Systematic Review

Introduction: Displaced intra-articular calcaneal fractures (DIACFs) are associated with a high incidence of wound complications. Minimally invasive approaches (MIAs) have enabled earlier intervention compared with the extensile lateral approach (ELA). However, the relationship between surgical timing, approach and outcome remains poorly defined. This systematic review evaluated the relationship between surgical timing, approach, and postoperative outcomes in DIACFs. Materials and Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Studies published between January 1990 and April 2026 were searched through PubMed, Embase and Web of Science. Studies reporting the timing to surgery, approach, and postoperative outcomes in operated DIACFs were included. Patients were stratified into three groups according to timing (0–7 days, 8–21 days, and >21 days). Complication rates, radiographic and functional outcomes were analyzed. Results: A total of 25 studies, encompassing 1915 patients, were included. Patients mostly underwent surgery within seven days (60.1%), followed by 8–21 days (37.8%) and >21 days (2.1%). The complication rate was 21.7%, with wound dehiscence (8.9%) and infection (5.2%) being the most prevalent. Dehiscence and necrosis were predominantly associated with the ELA, particularly between days 8–21. Infection rates increased when the delayed sinus tarsi approach was used. No differences were found in radiographic or functional outcomes. Conclusions: Surgical timing does not appear to be an independent outcomes predictor. Complications depend on the interplay of timing, approach, and soft-tissue condition. An individualized treatment, with no rigid temporal thresholds, is probably the best approach.