SynthesisJournal of robotic surgery2026
Clinical application of robot-assisted fixation for calcaneal fractures: a meta-analysis with subgroup comparisons.
Synthesis in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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