Abstract
Although various outcomes of the sinus tarsi approach have been reported, these are limited to the Sanders type 2 displaced intraarticular calcaneal fractures (DIACF) because of the limited visibility of the posterior facet joint. In this study we aimed to (1) introduce a sinus tarsi approach combined with an anterolateral fragment open-door technique that enables adequate visibility of the innermost and middle portion of the posterior facet joint, and (2) evaluate the radiographic and clinical outcomes of the patients treated with that technique. This is a retrospective case-series study performed on medical records of 25 patients who presented with the Sanders type 3 or 4 DIACF and were treated with the sinus tarsi approach. The radiologic measurements showed significant corrections of the Bohler’s angle, calcaneal width, length, height, and articular step-off in both X-rays and CTs in the last follow-up period. The mean AOFAS score was 90.08 ± 6.44 at the last follow-up. Among all the follow-up patients, two cases (8%) had acute superficial infections, and no other wound complications occurred. Therefore, we suggest that the Sanders type 3 or 4 DIACF could be successfully treated with the proposed technique with low complications and bring out effective clinical and radiologic outcomes.
Highlights
Controversies exist regarding an adequate surgical approach to produce optimal postoperative outcomes for a calcaneus fracture [1]
Among these less-invasive approaches, the sinus tarsi approach is known to be the most commonly used in the literature, having been modified into various forms since it was first introduced by Palmer [11,12]
In this study we introduce a sinus tarsi approach combined with an anterolateral fragment open-door technique in more severely displaced intra-articular calcaneal fractures (DIACF), that is, a Sanders type 3 or 4 fracture, that enables adequate visibility of the innermost and middle portion of the posterior facet joint followed by its anatomical restoration
Summary
Controversies exist regarding an adequate surgical approach to produce optimal postoperative outcomes for a calcaneus fracture [1]. An extensile lateral approach has been considered to be a gold-standard modality to access a calcaneus fracture, providing both complete exposure of the calcaneus and convenience of plate application [2]. Such an invasive approach has a critical drawback in terms of wound complications [3,4]. In an effort to minimize the inevitable complications of the extensile lateral approach, a variety of alternative, minimally invasive approaches have been developed [8,9,10] Among these less-invasive approaches, the sinus tarsi approach is known to be the most commonly used in the literature, having been modified into various forms since it was first introduced by Palmer [11,12]. Competitive clinical and radiologic outcomes of the sinus tarsi approach compared with the extensile lateral approach have been reported in
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