Sinus Tarsi Approach Research Articles

A simple modified technique for screw fixation of displaced intra-articular calcaneus fracture through a sinus tarsi approach: a comparison with plate fixation

BackgroundPlates and screws are frequently used for the fixation of displaced intra-articular calcaneus fracture (DIACF). In this study, we compared the outcomes of a modified screw fixation technique with plate fixation via a sinus tarsi approach (STA).MethodsA series of 187 DIACF patients who were treated via an STA using a plate fixation (n = 81) or a screw fixation (n = 106) were included. Screw fixation was done with two 2.7 mm screws and two 6.5 mm cannulated screws. Outcomes were evaluated radiographically and clinically. Clinical evaluations included pain assessment by Visual Analogue Scale (VAS) and functional assessment by the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire and Foot Function Index (FFI).ResultsThe mean final VAS was smaller in the screw group (P = 0.01). The mean AOFAS and FFI scores were not significantly different between the two groups (P = 0.17 and P = 0. 19, respectively). The mean improvement of Bohler’s angle, but not the Gissane’s angle, was significantly greater in the screw group (P = 0.014 and P = 0.09, respectively). The mean improvement of calcaneal length and height were not significantly different between the two groups (P = 0.78 and P = 0.22, respectively). The hardware removal rate was 14.8% in the plate group and 3.8% in the screw group (P = 0.007).ConclusionThe modified screw fixation method provides lower pain, better radiographic outcome, and lower rate of hardware removal compared to plate fixation in the treatment of DIACF.

The Lateral Sinus Tarsi Approach in Fixation of Displaced Intra-Articular Calcaneal Fracture. A Systematic Review & Meta Analysis

Abstract Background Minimally invasive reduction and fixation techniques via a sinus tarsi approach (STA) have been developed in an attempt to avoid the potential complications associated with an extensile lateral approach (ELA) and to be less invasive. Objective Minimally invasive approach including sinus tarsi approach (STA) in displaced intra articular calcaneal fracture displaced intra-articular calcaneal fractures (DIACF) with reference to: Change from baseline in calcaneal height, change from baseline in calcaneal width, change from baseline in calcaneal length, change from baseline in Bohler angle, change from baseline in Gissane angle. Methodology This meta-analysis was carried out in accordance with the Cochrane Handbook of Systematic Reviews of Intervention and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to answer the question of minimal invasive of lateral sinus tarsi in displaced intra articular calcaneal fracture. The study protocol was registered into the International Prospective Register of Systematic Reviews on September 09, 2020 with a registration number (PROSPERO: CRD42022359197). Results Running our search strategy on PubMed 69 studies, and the Cochrane library resulting in 221 studies and trials. We discarded 12 studies after screening the title and Abstract. Then we screened 18 studies to assess their eligibility for inclusion; and in last 10 years. The total sample size for this meta-analysis was 12 participants. 484 patients who completed STA surgery and 514 patients completed ELA surgery. Data Sources Medline databases (PubMed, cochrane) and all materials available in the Internet till 2023. Conclusion In conclusion, using the minimally invasive sinus tarsi approach (STA) is associated with a significant change in calcaneal height and Gissane angle when compared to extended lateral approach (ELA) when used to manage the displaced intra-articular calcaneal fractures (DIACF).

Minimally Invasive Sinus Tarsi Approach versus Extensile Lateral Approach for Sanders Type II & III Calcaneal Fractures (Systematic Review & Meta-analysis)

Abstract Background Open reduction and internal fixation (ORIF) is becoming more common in Calcaneal fractures of Sanders types II and III. The extensile lateral approach (ELA) appears to be the gold standard. Aim of the Work We aimed to compare the clinical outcomes of intra- articular calcaneus fractures treated with open reduction and internal fixation with via Extensile lateral approach (routine treatment) versus those via a sinus tarsi approach (minimally invasive treatment). Materials and Methods This systematic review conducted on 7 studies enrolled 734 patients with Sanders type II & III calcaneal fractures comparing he clinical outcomes of intra-articular calcaneus fractures treated with open reduction and internal fixation (ORIF) via Extensile lateral approach (routine treatment). The outcome measures considered: Postoperative wound complications, AOFAS score, Time to surgery, Surgical operative time, 24 hours Postoperative VAS score, Bohler's angle improvement, Gissane's angle improvement, Calcaneus width reduction, Recovery of calcaneus length, Length of hospital stay. Results Regarding postoperative wound complication, minimal invasive procedure significantly reduced the rate of wound complications other than open reduction. Concerning American Orthopedic Foot and Ankle Society score (AOFAS) score, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to time to surgery, there was a significant difference between ORIF and minimally invasive (MI) method. As regard surgical operative time, MI had a significant reduction in operative time. According 24 hours Post operative VAS score, there was no significant difference between ORIF and minimally invasive (MI) method. Concerning Bohler's and Gissane's angles improvement, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to calcaneus width reduction, there was no significant difference between ORIF and minimally invasive (MI) method. According recovery of calcaneus length, the current study showed no significant difference between ORIF and minimally invasive (MI) method. Concerning length of hospital stay, the ORIF consume more hospital stay than minimally invasive methods. Conclusion In contrast to ELA, minimal invasive procedure (STA) reduced the rate of wound complication. There was no significant difference between ELA and STA regarding the anatomical and functional outcome. The STA showed significant reduction in time to surgery and operative time.

Outcome study of operative treatment of displaced intra-articular calcaneal fractures by sinus tarsi approach & extensile lateral approach

Outcome study of operative treatment of displaced intra-articular calcaneal fractures by sinus tarsi approach & extensile lateral approach

Postoperative 3D computed tomographic evaluation of 92 calcaneal fracture reduction using the sinus tarsi technique and fixation with 3.5mm cortical screws.

Fixation of calcaneus through the sinus tarsi approach is increasingly popular due to the lower rate of wound complications. The use of postoperative CT provided a better evaluation tool than using plain radiography. Our objective of the present study is to evaluate the quality of fracture reductions by postoperative 3D CT scans after surgical intervention using the sinus tarsi approach and fixation with 3.5 cortical screws. Between January 2018 and April 2020, 86 consecutive patients with 92 closed displaced intra-articular calcaneal fractures underwent ORIF with 3.5mm screws constructed via a minimally invasive sinus tarsi approach by a single foot and ankle surgeon. The preoperative radiographic assessment found 36 joint depression type and 56 tongue type fractures according to the Essex-Lopresti classification. Preoperative CT assessment found 82 type II and 10 type III according to the Sander classification. Analysis of pre- and postoperative CT parameters showed that the height of the posterior facet, the length of the posterior facet, Gissane, and Bohler's angle were significantly improved. In addition, the means of posterior facet step-off in postoperative CT was 1.07, and 72% of posterior facet reductions were < 2mm step-offs. With postoperative CT scan assessment, the treatment of displaced intra-articular calcaneal fracture with 3.5mm screws via sinus tarsi approach has achieved good quality of reduction. Therefore, the screws-only technique is an option for treating calcaneal fracture with less soft tissue damage and implant cost.

CASE COMPARISON STUDY OF TWO SURGICAL APPROACHES FOR FIXATION OF CALCANEAL FRACTURES

BackgroundTraditionally, the extended lateral approach (ELA) was the favoured approch for calcaneal fractures, but has been reported to have high incidence of wound complications. There has been a move amongst surgeons in the United Kingdom towards the sinus tarsi approach (STA) due to its minimally invasive nature, attempting to reduce such complications.AimsTo evaluate outcomes of ELA and STA for all consecutive calcaneal fracture fixation in our institution over a 10yr period.MethodRetrospective cohort study of all calcaneal fractures surgically treated with either approach between January 2008 and January 2018. Anatomic restoration was assessed radiologically by the change in Gissane's and Bohler's angles and calcaneal width. Post-operative complications including metalwork removal were recorded.Results35 calcaneal fractures were managed surgically via either approach during this period (21 STA and 14 ELA). There was a statistically significant improvement in the radiological makers when the post-operative films were compared to pre-operative ones. When the post-operative films from the 2 groups were compared against each other, there was no significant difference (p&lt; 0.05) in any of the radiological markers. In the ELA group, 2 patients (14.3%) developed deep infections requiring metalwork removal and 1 had delayed wound healing (7.1%). No deep infections occurred with the STA; 1 patient (4.8%) had a superficial infection, treated with antibiotics. Of patients who had metalwork in situ for more than 1 year, 37.5% of the STA group required removal due to pain compared to only 16.7% with ELA.ConclusionsWe have moved from ELA to STA. Our results have shown no difference in restoration of calcaneal anatomy but with a decrease in post-operative wound complications including infection. However, we have shown an increase in metalware removal in the STA group and it is important to ascertain the cause and significance of this.

Stable Clinical and Radiological Outcomes at Medium and over 5 Year Follow Up of Calcaneus Fracture Open Reduction Internal Fixation Using a Sinus Tarsi Approach

The sinus tarsi approach is increasingly growing in popularity for open reduction internal fixation of calcaneus fractures. Multiple studies have demonstrated favorable short-term results compared to the traditional extensile L incision, however long-term data over 5 years is currently limited to a single retrospective case series. Following local ethical approval, all patients who had completed a minimum 5 years from time of operation were contacted with a Standardized Telephone Questionnaire completed. This followed a previous retrospective chart review, with follow up telephone or clinic consultation performed by Davey et al. of this cohort at mean 35 months. Thirty-four fractures (31 patients) completed minimum 5 year follow up from the eligible group of 54 fractures (49 patients). Regarding functional outcomes, a significant improvement in mean Maryland Foot Score was observed between short- (mean 35.8 months) and medium-term (mean 81.9 months) of 77.6 (SD 15.0) to 86 (SD 7.9) (p = .0082). There was no significant difference in postoperative and long term radiographic Bohler's angle (p = .9683). Eleven feet (32%) proceeded to require reoperation, with removal of metal performed in 10 (29%), fusion in 2 (6%), and skin grafting following wound breakdown for 1 (3%). Four feet (12.9%) experienced post operative wound complications, including 3 (9.68%) cases of infection and 2 (6.45%) of delayed wound healing. This study demonstrated stable clinical and radiographic outcomes over 5 years following Calcaneus Fracture Open Reduction Internal Fixation using a sinus tarsi approach, supporting its continued usage when treating intraarticular calcaneus fractures for which operative intervention is indicated.

Intra Articular Calcaneal Fracture with Subtaler Joint Depression: Minimally Invasive Sinus Tarsi Approach for Open Reduction and Internal Fixation

Background Numerous studies have demonstrated that fractures of the calcaneum, which account for a significant fraction of major tarsal bone fractures, are linked to severe and protracted impairment. This study aimed to evaluate minimally invasive sinus tarsi approach (STA) for open reduction and internal fixation of calcaneal fracture with joint depression to clarify and identify it benefits and drawbacks. Methods This prospective cohort research was performed on all adult cases with a displaced intra articular calcaneus fracture who were admitted to our institution. Patients aged of 14 to 60 years with unilateral, isolated, uncomplicated fractures were included. Results Our study conducted on 31patients with 34 fractures with a mean age of 34 years (type II 47% and type III 53%). The mean duration of follow-up was 20.45 months, the mean American orthopaedic foot and ankle society was 91.38% and the mean Maryland foot score was 94.79%. Pain and discomfort" were reported by 14 patients in regards to their foot. Seven individuals were found to have soreness at the locations of the posterior screws. The remaining 7 cases were identified as having complex regional pain syndrome, which is characterised by persistent foot pain, particularly when bearing weight. Sural nerve dystrophy was the only patient's complaint. One patient exhibited slight toe clawing. Conclusion The STA is a minimally invasive intervention utilised in the treatment of calcaneal fractures. It enables anatomic reduction of articular surfaces and allows for a clear view of the fracture.

Técnica quirúrgica del manejo de las fracturas de calcáneo a través de un abordaje del seno del tarso

Calcaneal articular fractures are fractures classically associated with a high rate of complications and poor outcomes. Osteosynthesis of the calcaneus through a sinus tarsi approach has shown results equal to or superior to those of the extended approach, having become the new gold standard.The objective of this article is to detail step by step the surgical technique of osteosynthesis of intra-articular fractures of the calcaneus through a sinus tarsi approach, from the selection of the fracture, positioning of the patient, layout of the operating room and the fluoroscope, the entire surgical process until postoperative treatment.The surgical technique described below is described in 6 steps.1.Layout of the operating room. Patient and Fluoroscope Positioning2.Reduction of the posterior tuberosity (correct height and varus)3.Sinus tarsi approach.4.Reduction of the articular surface and correct visualization. Arthroscopy5.Fixation of the articular surface6.Fixation of the posterior tuberosityAnatomical reduction of complex calcaneal fractures through an Sinus Tarsi Approach requires an understanding of the fracture and its associated deformities. Following the described sequence step by step will help to achieve a better reduction in order to achieve better functional results.

Functional outcomes after intramedullary nailing (C-Nail®) of severe calcaneal fractures with mean follow-up of 36 months

PurposeCalcaneal fractures (CFs) are rare but potentially debilitating injuries. Apart from the open, far lateral or sinus tarsi approach, operative treatment can be performed minimally invasive and percutaneously with intramedullary nailing. In this study, we sought to investigate the functional outcome of severe CFs treated with the C-Nail® implant.MethodsTwenty-two CFs (9 × Sanders III and 8 × Sanders IV), operated between 2016 and 2019, were followed up with a mean duration of 36 (± 11) months. The AOFAS score, pre- and postoperative Böhler angles, wound healing disorders, and patient-reported outcome measures (PROMs) like pain levels and return to work/sport levels were assessed.ResultsThe mean AOFAS score was 72.0 (± 9.8). Four patients sustained wound healing disorders, yet no implant-associated surgical revision was required. Fifty percent of patients were pain-free within 1 year. Within 1 year, about 50% of the patients could return to sports, and about 80% of the patients could return to work. PROMs and functional results align with those from other implants reported in the literature.ConclusionIntramedullary nailing of severe CFs with the C-Nail® implant can be considered a safe treatment alternative that yields acceptable results at mid-terms.

Comparative analysis of lateral extensile approach and sinus tarsi approach in the surgical treatment of calcaneal fractures: A retrospective study

Comparative analysis of lateral extensile approach and sinus tarsi approach in the surgical treatment of calcaneal fractures: A retrospective study

Comparison of percutaneous distractor and arthroscopic-assisted screw fixation with open reduction and plate fixation for Sanders II calcaneal fractures treatment: A single-center retrospective cohort study

BackgroundAlthough the numerous advancements in orthopedic surgical techniques and implants witnessed in recent decades, the management of calcaneus fractures remains among the most complex challenges in the field. This study introduced a percutaneous distractor and arthroscopic-assisted screw fixation (PDA-CRSF) technique and compared its wound-related complications and clinical efficacy with open reduction and plate fixation with sinus tarsi approach (STA-ORPF) for treating Sanders II calcaneal fractures. Patients and methodsThis retrospective cohort analysis evaluated two patient cohorts with Sanders II calcaneal fractures received either STA-ORPF or PDA-CRSF using clinical indicators time to operation, operation duration, blood loss volume, hospital stay, wound healing complications, nerve damage, American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, Visual Analogue Scale (VAS) score, and imaging indicators Gissane's angle (GA), Böhler's angle (BA), varus angle (VA), the length, height and width of calcaneal fractures, respectively. ResultsBetween March 2019 and March 2022, 23 patients underwent PDA-CRSF and 49 under STA-ORPF. The STA-ORPF group had fewer wound complications and nerve damage compared to the PDA-CRSF group (P < 0.05). Furthermore, the PDA-CRSF group exhibited shorter time to operation, reduced operation duration, decreased blood loss volume, and shorter hospital stay (P < 0.01). Three months after surgery, patients treated with PDA-CRSF also showed better scores on AOFAS (P < 0.01) and VAS (P < 0.05). However, at the final follow-up, the difference was not statistically significant (P = 0.222; P = 0.118). Both groups regarding radiographic indices had comparable outcomes at different postoperative follow-up stages. ConclusionThe results demonstrate that PDA-CRSF effectively reduces the risk of wound complications, shortens the surgical duration, expedites the time to surgery, and enhances post-operative rehabilitation.

Surgeon Learning Curve for the Sinus Tarsi Approach to Intra-articular Calcaneus Fractures - Improvement with Experience.

To analyze the relationship between surgeon experience with the sinus tarsi approach (STA) and outcomes in the treatment of displaced intra-articular calcaneus fractures (DIACF). Single level 1 trauma center. Retrospective.Patients/Participants: 103 consecutive DIACF (OTA/AO 82C; Sanders II-IV) treated operatively using STA from 2015 to 2021. Open management using the STA performed by two fellowship-trained orthopaedic traumatologists. Quality of anatomic reduction based on postoperative CT scans and standard radiographs. Sixty-six patients met inclusion criteria. Patients were primarily men (75.8%) with mean age 41 years (range 20-71 years), including 14 smokers (21.2%), 9 diabetics (13.6%), and 10 open fractures (15.2%). Sanders III fractures were most common (68.2% vs 28.5% and 6.1% Sanders II/IV respectively). Reduction quality was predominantly Good (59.1%, n=39) or Excellent (25.8%, n=17). Complications included wound necrosis (1), superficial infection (1), deep infection (1), and symptomatic posttraumatic arthritis requiring arthrodesis (3). There was a 29.3% reduction in likelihood of surgical complication with each year in surgeon experience with the STA and an 8.9% reduction per case (p<0.001). The likelihood of achieving a Good or Excellent reduction was 1.8 and 2.3 times greater than achieving a Fair reduction, respectively, for each year increase in surgeon experience with the STA (p=0.012 and 0.007, respectively). For each successive case, there was a 1.2 times greater likelihood of achieving a Good reduction (p=0.03). Surgeon experience plays a critical role in outcomes. We found that outcomes (reduction, complications) improve with each cumulative case and year of experience with the STA to treat DIACF. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Two-pin Posterior Tuberosity to Medial Wall Reduction Technique in Calcaneal Fracture Using Sinus Tarsi Approach

Introduction: The purpose of this study was to describe a novel technique in the surgical treatment of displaced intra-articular calcaneal fractures using 2 Schanz pins to reduce the posterior tuberosity to the medial wall (constant fragment) and correcting the varus malalignment while using the sinus tarsi approach. Materials and Methods: Twelve patients with calcaneal fractures Sanders type 2 and 3 underwent surgical fixation using this technique at our center from January 2021 to September 2021. One Schanz pin was inserted into the constant fragment and another one was inserted into the posterior tuberosity from lateral to medial. By holding the 2 pins the fracture fragments were first disengaged by applying a distraction force. The heel was then brought out of varus by a combination of maneuvres. The posterior calcaneal tuberosity pin was pushed medially and then the 2 pins were held together with one hand. The ankle was then dorsiflexed to lock the reduction. Harris heel views were taken to ensure reduction. Results: The mean Bohler angle improved from 7.5 degrees preoperatively to 29 degrees postoperatively. The mean Visual Analog Scale was 2.3 out of 10 at 6 months’ follow-up. None of the patients had wound complications, sural nerve neuropraxia, or revision surgery due to malreduction. Discussion: The 2-pin posterior tuberosity to medial wall reduction technique in calcaneal fractures using the sinus tarsi approach is a useful maneuver that can be used by orthopedic surgeons to correct the varus malalignment which is a frequent problem in calcaneal fracture fixation.

Prospective Clinical and Computed Tomography Evaluation of Calcaneus Fractures Treated Through Sinus Tarsi Approach.

The traditional lateral extensile approach to the calcaneus allows for excellent visualization but is associated with high wound complication rates. The sinus tarsi approach has been shown to produce similar radiographic outcomes with much lower rates of wound complications. The purpose of this study is to prospectively determine clinical and radiographic outcomes in calcaneus fractures treated with a sinus tarsi approach. Twenty-nine patients with 30 calcaneus fractures underwent operative fixation through a sinus tarsi approach and were prospectively evaluated. Routine pre- and postoperative radiographs were obtained, in addition to computed tomography (CT) scans at 6 weeks and 12 months after surgery. Patient-reported outcomes including American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) pain score, Veterans Rand 12-Item Health Survey (VR-12), and Foot Functional Index (FFI) were recorded. Patients were followed for a minimum of 1 year postoperation. Twenty-one patients with 22 calcaneus fractures completed 1 year of follow-up. At 12 months postoperation, 20 of 22 patients (91%) had 0 to 2 mm of fracture displacement at the posterior facet on CT scans whereas 2 of 22 patients had 2 to 4 mm of fracture displacement. There was no significant change in posterior facet fracture displacement comparing 6-week and 12-month postoperative CT scans (P > .99). Mean postoperative Bohler angle was 26.1 degrees compared to 13.2 degrees preoperatively. All patients had complete union of fracture site. There were no major wound complications. Four of 22 patients (18.2%) had minor wound complications. AOFAS, FFI, and VAS pain scores improved postoperatively but were not found to correlate with Bohler angle or critical angle of Gissane. We found that in select patients excellent anatomic alignment and good clinical outcomes with low wound complication rates can be achieved when fixing calcaneus fractures through the sinus tarsi approach. Level II, prospective cohort study.

Does the postoperative quality of reduction, regardless of the surgical method used in treating a calcaneal fracture, influence patients’ functional outcomes?

BackgroundThe extensile lateral approach (ELA) and sinus tarsi approach (STA) are commonly utilized for surgically treating calcaneal fractures. This study compared the outcomes of ELA and STA in the management of calcaneal fractures and assessed the influence of postoperative quality of reduction on functional and pain scores.MethodsThe study included 68 adults with Sanders type-II and type-III calcaneal fractures who underwent either ELA or STA surgery. Pre- and postoperative radiographs and computed tomography scans were analyzed, and functional and pain scores were evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and Visual Analogue Score (VAS) during follow-up visits.ResultsOut of the total patients, 50 underwent ELA surgery while 18 underwent STA surgery. The anatomic (excellent) reduction was achieved in 33 (48.5%) patients. There were no significant differences between the ELA and STA groups concerning functional scores, pain scores, the proportion of excellent reduction, and complications. Additionally, anatomic reduction, compared to near or non-anatomic (good, fair, or poor) reduction, demonstrated a decrease in MOXFQ (unstandardized β coefficient: -13.83, 95% CI: -25.47 to -2.19, p = 0.021), an increase in AOFAS (unstandardized β coefficient: 8.35, 95% CI: 0.31 to 16.38, p = 0.042), and a reduction in VAS pain (unstandardized β coefficient: -0.89, 95% CI: -1.93 to -0.16, p = 0.095) scores.ConclusionIn conclusion, we found no significant differences regarding complications, excellent reduction, and functional scores between STA and ELA surgeries. Therefore, STA may be an effective alternative for the treatment of calcaneal fractures in Sanders type II and type III calcaneal fractures. Furthermore, the anatomic reduction of the posterior facet correlated with improved functional scores, emphasizing the importance of achieving it for restoring foot function regardless of surgery type or time between injury and surgery.

Emergency surgery of intra-articular calcaneal fractures using sinus tarsi approach with modified reduction technique

BackgroundThe purpose of this study was to evaluate emergency surgery of calcaneal fractures using the sinus tarsi approach (STA) with modified reduction technique in terms of complication rates, iconography results and functional outcome.MethodsWe evaluated the outcomes of 26 patients treated in an emergency using STA with modified reduction technique. For that, we assessed Böhler´s angle, Gissane angle, reduction of the calcaneal body, and posterior facet, the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, complications, preoperative time, operative time, and in-hospital time.ResultsRecovery of calcaneal anatomy and articular surface were found at final follow-up. The mean Böhler´s angle at final follow-up were 30.68° ± 3.69°, of which was 15.02° ± 3.88° preoperatively (p < 0.001). The mean Gissane angle at final follow-up were 114.54° ± 11.16° of which was 88.86° ±10.96° preoperatively (p < 0.001). All cases had the varus/valgus angle of the tuber within 5 degrees. At the final follow-up, the mean AOFAS score was 89.23 ± 4.63, and the VAS score was 22.73 ± 6.5.ConclusionsEmergency surgery using STA with modified reduction technique is reliable, effective, and safe for treatment of calcaneal fractures. This technique can bring good clinical outcomes and a low rate of wound complications, reducing the in-hospital time, costs, and accelerating rehabilitation.

Surgical treatment of intra-articular calcaneus fractures with plate osteosynthesis via the sinus tarsi approach

Surgical treatment of intra-articular calcaneus fractures via aminimally invasive approach. Intra-articular dislocated calcaneus fractures. Fracture older than 14days; poor soft tissue quality in the surgical area. Patient in lateral position. Identifying the anatomic landmarks. Incision (3-5 cm) from the tip of the fibula to metatarsalIV. Preparation through the subcutis. Retraction of the peroneal tendons. Preparation of the lateral calcaneal wall and later plate position via raspatory. Placement of aSchanz screw in the calcaneal tuberosity from lateral or posterior as areduction aid for restoring of the calcaneal length and reduction of the hindfoot varus. Reduction of the sustentaculum fragment with the help of fluoroscopy from lateral. Elevation of the subtalar articular surface. Positioning of the calcaneal plate and fixation of the sustentaculum fragment by placing acannulated screw through the long hole. Afterwards, definite internal fixation of the reduction with locking screws. Completion of the operation with final X‑rays and, if available, an intraoperative computed tomography. Wound closure with closing of the peroneal sheath. Lower leg-foot orthoses. Mobilization with partial weight-bearing of the injured foot with 15 kg for 6-8weeks; subsequently increased load bearing. Due to the smaller incision and the associated lower soft tissue trauma, the risk of wound healing complications can be reduced. Radiographic and functional outcomes are comparable to the outcomes of calcaneal fractures treated via the extended lateral approach.

Implant Choice and Outcomes of the Sinus Tarsi Approach for Displaced Intra-articular Calcaneal Fractures.

Operative fixation of displaced intra-articular calcaneal fractures is considered the gold standard, for which multiple fixation methods are available. This study compares the (functional) outcome of screw fixation (SF), plate fixation (PF), and anatomical plate fixation (APF) via the sinus tarsi approach (STA). A total of 239 patients (265 fractured calcanei) who received surgical treatment of a displaced intra-articular calcaneal fracture via STA between 2011 and 2022 were included. Böhler angle (BA) measured immediately postoperatively (BA post-OR) and the decrease in BA at 1 year (∆BA) differed significantly in favor of PF/APF compared with SF (BA post-OR: SF vs PF P = .010 and SF vs APF P = .001; ∆BA: SF vs PF P = .032 and SF vs APF P = .042). Implant removal surgery was performed significantly less in the APF group as compared to the SF/PF groups (APF vs SF/PF; 9.9% vs 22.9%/23.7%, P = .015). Surgical site infections and secondary arthrodesis of the subtalar joint occurred equally in the 3 groups. Furthermore, the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index score, and EuroQOL-5D-index / visual analog scale score, did not differ notably between SF, PF, and APF. The results show that both PF and APF are favored over SF because of an improved correction of BA measured directly postoperatively, a lower secondary loss of BA and, for APF, a lower implant removal rate. There was no difference in the rate of surgical site infections, need for secondary arthrodesis, nor functional outcome scores between different implants using the STA. Level III, retrospective cohort study.

The Extensile Lateral Approach to the Calcaneus

Accounting for 1% to 2% of all fractures, calcaneus fractures are the most common tarsal bone fracture. Although often managed nonoperatively, operative management is preferred for cases that involve significant displacement, joint height loss, and malalignment in patients with limited complication profiles. The extensile lateral approach has historically been a commonly utilized approach for the operative management of displaced calcaneus fractures. Although minimally invasive approaches, such as the sinus tarsi approach, have gained recent traction, they have inherent limitations that result in the extensile lateral approach being the preferable technique in certain cases. In this technique guide, we outline the surgical technique for calcaneus fracture repair using the extensile lateral approach and reported outcomes in the literature. Level of Evidence: Level 5.