Abstract
Open reduction and internal fixation of displaced intraarticular calcaneal fractures remain the gold standard of treatment, but the traditional extensile approach has been associated with relatively frequent complications. The current study aims to evaluate the less invasive sinus tarsi approach and to elaborate on the associated complications, risk factors, and outcome predictors. A retrospective observational study was carried out among 39 patients diagnosed with calcaneal fractures that were operatively treated between January 2019 and January 2020 at a level-one trauma center in Riyadh, Saudi Arabia. Patients were assessed regarding the complications, pre- and postoperative Bohler's angle, Gissane’s angle, calcaneal height, and return to baseline function. Patients older than 60 years show significantly more complications compared to younger patients (p < 0.05). Type IV calcaneal fracture, according to Sander’s classification, showed significantly more complications than other types (p < 0.05). There were significant variations in pre- and postoperative Bohler's angle and calcaneal height (p < 0.05). These variations apply to the Gissane’s angle but do not rise to significant results (p > 0.05). Furthermore, the current study reports a significant moderate direct correlation between delay time and complication incidence (p < 0.05). In conclusion, the minimally invasive sinus tarsi approach has relatively low complications and excellent clinical and radiological outcomes. Older patients and those who are diagnosed with type IV calcaneal factures, besides those presented with more delay, are more associated with unfavorable complications.
Highlights
Fractures of the calcaneus are the most common tarsal fractures and represent approximately 2% of all fractures; they are almost consistently caused by direct trauma to the foot either due to accidental fall, deliberate suicide attempt, or a motor vehicle collision [1]
This study enrolled a total of 39 calcaneal fracture patients who were presented to the emergency room (ER) and admitted with a diagnosis of closed calcaneal fractures
The current study reveals that the rate of complications after operative repair with minimally invasive sinus tarsi approach (5/39) * 1000 populations = 128.2
Summary
Fractures of the calcaneus are the most common tarsal fractures and represent approximately 2% of all fractures; they are almost consistently caused by direct trauma to the foot either due to accidental fall, deliberate suicide attempt, or a motor vehicle collision [1]. Displaced fractures with an intraarticular component represent over two-thirds of calcaneal fractures and, cause significant functional morbidity [2]. Conservative management of these fractures in whichever form may result in suboptimal functional results and significantly poor patient satisfaction [3]. Of particular interest to this study is the Sanders classification system, which is relatively easy to implement if computed tomography is available; it could guide surgical management and provide prognostic value.
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