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Abstract
Introduction: The lateral extensile approach has been a widely accepted surgical approach in treatment of intraarticular calcaneal fracture. It provides good exposure for fixation by correcting the hindfoot varus, fracture reduction and restores calcaneal height but it has a high wound complication rate. Methods and materials: 36 intraarticular calcaneal fractures (Sanders II, III and IV) treated using the lateral extensile approach in 34 patients presenting between 2015 and 2018 were retrospectively reviewed. Wound complication in the early stage (day 1 to day 3), intermediate (2 weeks) and late (6 weeks) were documented. Results: We found early (Day 1 - Day 3) infection rate of 5.6%, intermediate (2 weeks) at 17.6% and late wound complication (6 weeks) at 2.9%. Conclusion: Lateral expansile approach is a reliable surgical exposure for fracture reduction of calcaneal fractures with acceptable wound related complication rate. Minimally invasive techniques and the sinus tarsi approach are being used for less comminuted fractures, but those techniques are technically more demanding. Smoking, long duration of surgery and soft tissue handling also play a role in increasing wound complication rates.
Highlights
The lateral extensile approach has been a widely accepted surgical approach in treatment of intraarticular calcaneal fracture
We present our current data with regards to wound complications associated with the lateral extensile approach, to assess its feasibility in treatment of calcaneum fracture fixation
There were 36 calcaneum fractures in 34 patients treated with lateral extensile approach in this study. 30 out of the 34 patients were male and majority of them were industrial workers who sustained the fracture from motor vehicle accident or fall from height at the construction site
Summary
The lateral extensile approach has been a widely accepted surgical approach in treatment of intraarticular calcaneal fracture It provides good exposure for fixation by correcting the hindfoot varus, fracture reduction and restores calcaneal height but it has a high wound complication rate. Open reduction and internal fixation with calcaneal plate (conventional or locking) via a lateral extensile approach have been considered a standard treatment for displaced intraarticular calcaneal fractures because it provides excellent exposure of the fracture site. It allows direct reduction of the depressed posterior facet fragment, addresses the blow-out lateral wall and corrects the malalignment tuberosity. Al-Mudhaffar et al and Vaclav et al reported an overall wound complication rate for lateral extensile approach of 24%, 18.1% and 17% respectively [3] [4] [5]
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