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Sanders type 3AB calcaneal fracture treated through sinus tarsi approach with screws only fixation. A, preoperative lateral view, (B) preoperative axial CT image, (C) postoperative lateral view, (D) postoperative axial CT.
Source publication
Objectives: To investigate whether the sinus tarsi approach (STA) allows for a similar anatomical reduction of the posterior talocalcaneal facet as the extended lateral approach (ELA) and compare the rate of postoperative wound complications.
Design: Retrospective.
Setting: Level 1 Trauma Center.
Patients: All consecutive patients from 2012 to 2015...
Contexts in source publication
Context 1
... characteristics collected were sex, age at the time of trauma, diabetes mellitus, use of nicotine, drug abuse, and American Society of Anesthesiologists (ASA) classifica- tion. Fracture characteristics were measurement of the pre- operative Böhler's angle (BA) on the lateral radiographic images and computed tomography (CT) classification (Sanders and Essex-Lopresti) based on lateral and axial CT in all patients (Figs. 1A, B and Figs. 2A, B). Treatment characteristics included type of approach, time to surgery, duration of the procedure, duration of hospital admission after ORIF, surgical interventions due to wound complications with subsequent number of readmissions and total hospital stay. All patients were seen at regular intervals (2,8,26, and 52 weeks) postoperatively by a trauma surgeon specialized in foot and ankle ...
Context 2
... assess the accuracy of the reduction of the posterior talocalcaneal facet, postoperative CTs were obtained ( Fig. 1D and Fig. 2D). 23 The largest step-off seen on the semicoronal reconstructions was measured in millimeters (mm). A value of 0 to ,1 mm indicated an anatomic reduction, 1 to ,3 mm indicated a near anatomic reduction, 3-5 mm was considered an approximate reduction, and .5 mm was considered a failure of reduction. 1,4 The width of the calcaneus was measured on the axial CT just below the sustentaculum tali. Postoperative conventional radiographs were performed at 6 to 8 weeks consisting of a lateral view, axial view, and a 30-40 degree Brodén view. The postoperative BA was measured using the lateral view ( Fig. 1C and Fig. 2C). The axis of the tuber was measured using the axial view and considered normal with a varus/valgus angle of ,5 degree. ...
Context 3
... assess the accuracy of the reduction of the posterior talocalcaneal facet, postoperative CTs were obtained ( Fig. 1D and Fig. 2D). 23 The largest step-off seen on the semicoronal reconstructions was measured in millimeters (mm). A value of 0 to ,1 mm indicated an anatomic reduction, 1 to ,3 mm indicated a near anatomic reduction, 3-5 mm was considered an approximate reduction, and .5 mm was considered a failure of reduction. 1,4 The width of the calcaneus was measured on the axial CT just below the sustentaculum tali. Postoperative conventional radiographs were performed at 6 to 8 weeks consisting of a lateral view, axial view, and a 30-40 degree Brodén view. The postoperative BA was measured using the lateral view ( Fig. 1C and Fig. 2C). The axis of the tuber was measured using the axial view and considered normal with a varus/valgus angle of ,5 degree. ...
Citations
... The sinus tarsi approach is associated with less wound complications, time to surgery, and operating time [11][12][13]. Although this approach provided good exposure to subtalar joint, requires considerable experience and learning curve of the surgeon [1]. ...
... The 3D CT parameters of alignments after an operation by the screws-only technique in our study resembled that of the normal calcaneus, similar to a previous study (Table 4), except for Bohler's angle which is the important parameter that reflects the functional outcome of patients [12,14]. The mean postoperative Bohler's angle of calcaneus fracture using sinus tarsi approach in previous study was 25.5 which close to our study [15]. ...
Background
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.
Methods
Between January 2018 and April 2020, 86 consecutive patients with 92 closed displaced intra-articular calcaneal fractures underwent ORIF with 3.5 mm screws constructed via a minimally invasive sinus tarsi approach by a single foot and ankle surgeon.
Results
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 < 2 mm step-offs.
Conclusion
With postoperative CT scan assessment, the treatment of displaced intra-articular calcaneal fracture with 3.5 mm 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.
... The ELA has been traditionally favored for its ability to provide superior visualization to aid direct reduction of the fracture fragments and restoration of subtalar joint articular congruency [19,20,24,39]. However, despite its limited direct visualization, the STA approach can achieve similar radiographic outcomes as reported by the postoperative Böhler angle (ELA: 26.62°vs STA: 27.13°) and angle of Gissane (ELA: 122°vs STA: 121.68°) analyzed [16][17][18][19][20]23,25,27,28,[30][31][32][33][34][35]. Furthermore, the final postoperative measurements of calcaneal height, length, and width were found to be nearly equivalent with no statistically significant differences. ...
... 1,18,31,44 Because of wound complications associated with the extended lateral approach, many surgeons have moved to a sinus tarsi approach, which is associated with equivalent quality of reduction and potentially associated with fewer wound complications, greater functional outcomes, and lower complication rates. 25,41,42 Some surgeons argue that primary surgical intervention is warranted in order to try to reduce late complications associated with nonoperative management which includes pain, functional limitations, and secondary arthritis (many of which require late surgical intervention such as arthrodesis for treatment). 7,8 Objective The aim of this study was to investigate the clinical and radiologic outcomes of the minimally invasive sinus tarsi approach for displaced intraarticular calcaneal fractures and compare these to a comparator cohort of patients managed nonoperatively. ...
... 25 We found a relatively low rate of complications following this approach, suggesting the minimally invasive surgical techniques in this study are safe with lower rates of surgical complications than open techniques at 2 years reported in the literature. 25,34,40,42,48 Our wound complication rate (defined as surgical site infection or wound dehiscence) was 16%, which was higher than wound infection rates reported in other series of calcaneal fractures managed through a sinus tarsi approach (5%) but lower than the extended lateral approach (25%). 4,25,28,40,42,47 However, the prevalence of smoking was higher in our series, and we included all patients who had a partial or small wound (n = 2) dehiscence or delayed wound healing (n = 3). ...
... 25,34,40,42,48 Our wound complication rate (defined as surgical site infection or wound dehiscence) was 16%, which was higher than wound infection rates reported in other series of calcaneal fractures managed through a sinus tarsi approach (5%) but lower than the extended lateral approach (25%). 4,25,28,40,42,47 However, the prevalence of smoking was higher in our series, and we included all patients who had a partial or small wound (n = 2) dehiscence or delayed wound healing (n = 3). Even so, this is lower than that reported in the UK heel fracture trial, which reported a 19% infection rate and 11% secondary surgery when using an extensile lateral approach. ...
Background
Optimal management of displaced intraarticular calcaneal fractures remains controversial. The aim of this prospective cohort study was to compare the clinical and radiologic outcomes of minimally invasive surgery vs nonoperative treatment in displaced intraarticular calcaneal fracture up to 2 years.
Methods
All displaced intraarticular calcaneal fractures between August 2014 and January 2019 that presented to a level 1 trauma center were considered for inclusion. The decision to treat was made by a multidisciplinary team consisting of fellowship-trained orthopaedic surgeons. Operative treatment protocol involved sinus tarsi approach or percutaneous reduction and internal fixation. Nonoperative protocol involved symptomatic management with no attempt at closed reduction. The Manchester-Oxford Foot Questionnaire (MOXFQ) and EuroQol–5 Dimensions–5 Level (EQ-5D-5L) patient-reported outcome measures were used to assess foot and ankle and general health related quality of life outcomes, respectively, at 2-year follow-up. Radiographic assessment was performed based on preinjury and 12-week postinjury radiographs.
Results
A total of 101 patients were included for analysis between August 2014 and January 2019. We propensity score matched 46 patients in the surgical cohort to 46 patients in the nonsurgical cohort. At 24 months, there was no significant difference in the MOXFQ Index score ( P > .05); however, the surgical cohort had a significantly higher EQ-5D-5L Index score ( P < .05) and return to work (91% vs 72%, P < .05) and physical activity rate (46 vs 35%, P < .05) despite a higher proportion of more complex fractures in the surgical cohort. The wound complication rate following surgery was 16%. In addition, 14% of patients in the nonoperative cohort subsequently underwent arthrodesis compared with none of the patients in the surgical cohort.
Conclusion
In this study, we found that operative treatments were associated with low rates of surgical complication at 2 years and long-term pain improvement, facilitating earlier and better functional outcomes for complex injury patterns compared with nonoperative treatment for less severe fractures.
Level of Evidence
Level III, retrospective cohort.
... However, this approach is associated with wound complications in as high as 32% of cases. 2 Modern techniques using a sinus tarsi approach have proven to produce similar clinical and radiographic results with much lower rates of wound complications and shorter operative times. 6,19,23,26 The purpose of this study was to prospectively evaluate radiographic and clinical outcomes, computed tomography (CT) scans at 6 weeks and 1 year postoperation, and patientreported outcomes from a series of patients treated with a sinus tarsi approach for calcaneus fracture fixation. ...
Background
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.
Methods
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.
Results
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.
Conclusion
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 of Evidence
Level II, prospective cohort study.
... The primary benefit to this approach is minimal soft dissection particularly of the lateral skin of the hindfoot and several studies have demonstrated lower wound complication rates and decreased surgical time with the ST approach. [14][15][16][17][18][19][20][21][22][23] However, few studies have compared the EL and ST approaches for comminuted, displaced, intra-articular fractures, including AO-OTA 82-C3 (Sanders type IV) fractures. These severely comminuted fracture patterns have been associated with poor outcomes even with open treatment and acute arthrodesis should be highly considered. ...
... Several studies have demonstrated the utility and efficacy of minimally invasive approach for the treatment of displaced intra-articular calcaneal fractures. 15,16,[21][22][23] One of the earliest comparative studies by Weber et al 23 Xia et al 24 compared the two approaches for 117 calcaneal fractures in a randomized control trial and found decreased surgical times and equivalent postoperative radiographic measurements. More recently, a study of 125 calcaneus fractures by Schepers et al 21 utilized postoperative CT scans to evaluate the quality of reduction. ...
Background:
The aim of the study is to investigate the differences between the extensile lateral (EL) and sinus tarsi (ST) approaches for the treatment of displaced intra-articular calcaneus fractures as treated by a single surgeon.
Methods:
A retrospective cohort study performed at a Level 1 trauma center. One hundred twenty-nine consecutive intra-articular calcaneus fractures from 2011 to 2018 that were surgically treated by a single surgeon. Primary outcomes were time to surgery, operative time, postoperative restoration of the critical angle of Gissane, postoperative wound complications, and need for unplanned re-operation.
Results:
Patient characteristics, including demographics, mechanism of injury, and fracture patterns were similar between the EL and ST approach groups. There was a significant decrease in unplanned secondary procedures (P = .008), shorter time to definitive fixation (P = .00001), and shorter average operative time in the ST group (P = .00001). Postoperative measurement of the critical angle of Gissane between the two groups was significantly different, but minute with an average difference of approximately 3 degrees (P = .025). Measurements in both groups were within the expected range of normal.
Conclusions:
For displaced intra-articular calcaneus fractures, a limited open ST approach is associated with a significant reduction in the time to definitive fixation and decreased operative time. The EL approach was associated with a small, but significant improvement in the restoration of the critical angle of Gissane compared with the ST approach. Therefore, an ST approach may allow for earlier surgical intervention and result in equivalent quality of reduction compared with an EL approach.
Level of evidence:
Level III.
... El abordaje mininvasivo del seno del tarso permite una adecuada visualización y reducción de la fractura, lo que disminuye la tasa de complicaciones. 8 El objetivo de nuestra investigación fue describir los resultados radiográficos y funcionales, y las complicaciones de la osteosíntesis de fracturas de calcáneo mediante el abordaje del seno del tarso. ...
... 4 Los abordajes quirúrgicos siguen generando controversia, pero se ha demostrado que las técnicas mininvasivas disminuyen las complicaciones de partes blandas y las infecciones comparadas con el ALE. 7,8 El abordaje del seno del tarso podría ser considerado actualmente el patrón de referencia porque logra bajas complicaciones de partes blandas y resultados clínicos similares a los del ALE. 16 La mejoría significativa del ángulo de Böhler posoperatorio en este estudio nos demuestra que, a través de esta incisión, se puede restaurar la altura del calcáneo. ...
Objetivo: Describir los resultados radiográficos y funcionales, y las complicaciones de la osteosíntesis de fracturas de calcáneo mediante el abordaje del seno del tarso. Materiales y Métodos: Se evaluaron 54 fracturas articulares de calcáneo desplazadas en 50 pacientes con radiografías de pie, de frente y de perfil, y tomografía computarizada preoperatorias. Se tomaron radiografías de pie, de frente y de perfil sin carga en el posoperatorio inmediato y con carga a las semanas 6 y 12, y al final del seguimiento. Se midió el ángulo de Böhler y se cuantificó el grado de artrosis subastragalina y calcaneocuboidea. Se determinó el puntaje de la AOFAS y se registraron las complicaciones de la herida, las lesiones neurológicas y la necesidad de cirugías adicionales, como retiro del material de osteosíntesis y artrodesis subastragalina. Resultados: El seguimiento fue de 30.8 meses. La serie estaba formada por 8 mujeres y 42 hombres, con una edad de 39.40 ± 14 años (rango 18-65). Cuarenta fracturas eran Sanders tipo II, 13 tipo III y 1 tipo IV. El puntaje de la AOFAS fue: excelente (12 casos), bueno (25 casos), regular (12 casos) y malo (5 casos). El ángulo de Böhler preoperatorio era de 10,8 ± 10,4° y 30,77 ± 8,24° al final del seguimiento (p <0,00001). El 3,7% tuvo complicaciones menores de la herida y el 5,6%, complicaciones mayores. Conclusión: El abordaje del seno del tarso permite una reducción aceptable con resultados buenos y excelentes en la mayoría de los pacientes y escasas complicaciones de partes blandas.
... Причем раневые осложнения после мини-инвазивного доступа, в основном, поверхностные, в то время как после ORIF из ELA доступа третья часть осложнений глубокая. Сравнение функциональных исходов лечения при ORIF из ELA доступа и при мини-инвазивном через STA доступ при переломах типа Sanders III показало их сопоставимость [75, [81][82][83][84][85]. Так, интенсивность боли в стопе по шкалам ВАШ после ORIF из ELA доступа составила 2,4 балла, после мини-инвазивного STA доступа -2,1 балла. ...
Лечение внутрисуставного многофрагментарного перелома пяточной кости с импрессией, вдавлением суставной фасетки в тело пяточной кости, остается сложной задачей, а оптимальный подход до сих пор окончательно не выработан. Артроз подтаранного сустава является частым последствием внутрисуставного перелома пяточной кости, а его развитие связано с тяжестью разрушения задней суставной фасетки, качеством репозиции и стабильности фиксации. Основной целью данного исследования было выявление нерешенных аспектов лечения внутрисуставных компрессионных переломов пяточной кости. Произведен обзор литературы в доступных базах данных: PubMed, Medline, Embase, Cochrane Library, опубликованных с 2000 по 2022 года. А также взяты для анализа источники ранее 2000 года, содержащие концептуальную информацию. Поиск публикаций и оценка качества производилась двумя независимыми исследователями. Оценивали результаты репозиции и последующего лечения консервативными и оперативными методами, баллы клинических исходов, рентгенографические данные, частоту осложнений. В случае возникновения разногласий окончательное решение принималось путем обсуждения. Из 262 рецензируемых статей в данный обзор включены 103 полнотекстовые статьи, в которых отражены сведения о лечении внутрисуставных переломов пяточной кости консервативными и оперативными методами с рентгенологической, артроскопической и 3Dвизуализационной оценкой результата репозиции, клиническом исходе лечения по шкалам ВАШ и AOFAS, осложнений. На настоящий период разработана обоснованная технология лечения внутрисуставных переломов пяточной кости в зависимости от тяжести перелома. При переломах IIтипа по Sanders благоприятные исходы лечения обеспечивает закрытая чрескожная репозиция под рентгеноскопическим и артроскопическим контролем и чрескожная фиксация винтами, блокируемым стержнем. При переломах III типа по Sanders благоприятные функциональные исходы достигнуты при репозиции задней суставной фасетки из минимально инвазивного доступа в Sinus tarsi(STA) под контролем рентгеноскопической оценки и 3D визуализации O-arm дугой, фиксация перелома винтами, специальной пластиной. При самых тяжелых многооскольчатых переломах IVтипа по Sanders вопрос о выборе метода лечения остается до сих пор окончательно нерешенным. Для подтверждения эффективности открытого остеосинтеза необходимы контролируемые проспективные исследования с долгосрочным наблюдением.
Буын фасеткасының батық импрессиясымен өкшесүйектің көпфрагментті буынішілік сынуын және өкшесүйек денесін емдеу қиын міндет болып қала береді, ал оңтайлы әдіс әлі түпкілікті әзірленбеген және толық шешілмеген. Бұл сынықтарды емдеу дамып келеді. Топайасты буынның артрозы - өкшесүйектің буынішілік сынуының жиі салдары және оның дамуы буынның артқы фасеткасы бұзылысының ауырлығымен, репозиция сапасымен және бекітудің тұрақтылығымен байланысты. Бұл зерттеудің негізгі мақсаты өкшесүйектің буынішілік компрессиялық сынуларын емдеудің шешілмеген, даулы аспектілерін анықтау болды. Екінші мақсаттар Sanders жіктемесіне сәйкес артқы буындық фасеткасының зақымдану ауырлығына байланысты емдеудің функционалдық нәтижелерін, сынулардың жиілігін, асқынуларын бағалау болды. PubMed, Medline, Embase, Cochrane Library қолжетімді деректер қорындағы әдебиеттерге, сондай-ақ 2000 жылданбастап 2022 жылдың наурызына дейін жарияланған орыс тілді білім инфрақұрылымына шолу жасалды. Жарияланымдарды іздеу мен сапасын бағалауды екі тәуелсіз зерттеуші жүргізді. Репозиция және консервативті және хирургиялық әдістермен кейінгі емдеу нәтижелері, клиникалық нәтижелердің баллдары, рентгенографиялық деректер, асқынулардың жиілігі бағаланды. Келіспеушілік туындаған жағдайда соңғы шешім талқылау арқылы қабылданды. Рецензияланған 262 мақаланың ішінен бұл шолуға 103 толық мәтінді мақала енгізілді, оларда репозиция нәтижесін рентгендік, артроскопиялық және 3D визуализациясы арқылы консервативті және хирургиялық әдістермен буынішілік сүйек сынықтарын емдеу, клиникалық ВАШ және AOFAS шкалалары бойынша емдеу нәтижелері мен асқынулар туралы мәліметтер көрсетілген. Травматологияның қазіргі дамуы кезеңінде өкшесүйектің буынішілік сынықтарын емдеудің негізді технологиясы сынықтың ауырлығына байланысты әзірленді. Sanders бойынша II типті сынықтарда емдеудің қолайлы нәтижелері рентгеноскопиялық және артроскопиялық бақылауда жүргізілетін жабық тері арқылы репозиция және бұрандалар мен бұғытталатын стерженьдермен тері арқылы бекітумен қамтамасыз етіледі. Sanders бойынша ІІІ типті сынықтарында рентгеноскопиялық бағалау және O- arm доғасымен 3D визуализациясымен, сынықтарды бұрандалар, арнайы пластиналармен бекітілуін бақылауымен Sinus tarsi (STA) кіші инвазиялық жетумен буынның артқы фасеткасының репозициясы кезінде қолайлы функционалдық нәтижелерге қол жеткізілді. Sanders бойынша IV типті ең ауыр көп бөлікті сынықтарда емдеу әдісін таңдау мәселесі әлі де үзілді-кесілді шешілмеген. Ашық остеосинтездің тиімділігін растау үшін ұзақ мерзімді бақылаумен бақыланатын перспективалық зерттеулер қажет.
Treatment of an intraarticular multifragmentary fracture of the calcaneus with depression of the articular facet and body remains a challenge, and the optimal approach has not yet been fully developed. The treatment of these fractures has evolved. Arthrosis of the subtalar joint is a common consequence of intra-articular fracture of the calcaneus, and its development is associated with the severity of the destruction of the posterior articular facet, the quality of reposition and the stability of fixation. The main purpose of this study was to identify unresolved, debatable aspects of the treatment of intra-articular compression fractures of the calcaneus. Secondary goals were to assess the functional outcomes of treatment, the frequency, complications of fractures depending on the severity of damage to the posterior articular facet according to the Sanders classification. A review of the literature in the accessible database PubMed, Medline, Embase, Cochrane Library, as well as the Russian-language infrastructure of knowledge, published from 2000 to March 2022. The publication search and quality assessment was carried out by two independent researchers. The results of reposition and subsequent treatment with conservative and surgical methods, scores of clinical outcomes, radiographic data, and the frequency of complications were evaluated. In case of disagreement, the final decision was made by discussion. Of the 262 peer-reviewed articles, this review includes 103 full-text articles, which include information on the treatment of intra-articular fractures of the calcaneus conservative and operative methods with X-ray, Arthroscopic and 3Dvisualizing evaluation of the reposition result, clinical outcome of the VAS and AOFAS treatments, complications. For the present period of development of traumatology, a reasonable technology for the treatment of intra-articular fractures of the calcaneus has been developed, depending on the severity of the fracture. In Sanders type II fractures, favorable treatment outcomes are provided by closed percutaneous reposition under fluoroscopic and arthroscopic control and percutaneous fixation with screws and interlocking nail. In Sanders type III fractures, favorable functional outcomes were achieved with reposition of the posterior articular facet from the minimally invasive approach to Sinustarsi (STA) under fluoroscopic control and 3D visualization with an O-arm, fixation of the fracture with screws, a special plate. In the most severe multi-comminuted fractures of type IV according to Sanders, the question of choosing a method of treatment still remains unresolved. Controlled prospective studies with long-term follow-up are needed to confirm the open osteosynthesis effectiveness.
... In their retrospective cohort study (40 patients underwent the EL approach to ST 60 patients) comparing the EL approach and the minimally invasive approach performed with the ST incision in 100 patients with type 2 and 3 calcaneal fractures, they reported that high complication rates, especially skin complications, were observed in the EL group. 2 A study comparing the two methods and including 125 patients reported that ST reduced wound complications and shortened the duration of surgery and had these advantages but no adverse effect on fracture reduction. 12 In the systematic review that included 256 patients with 271 calcaneal fractures and eight studies, minor skin complications were reported in 4.1% of patients treated minimally invasively with the ST method. In contrast, the rate of significant skin complications was 0.7%. ...
z Purpose: The aim of this stud was to compare the clinical and radiological results between Sinus-tarsi (ST) and Extended-Lateral (EL) approaches in open reduction internal fixation of intra-articular calcaneal fractures. Materials and Methods: 51 calcaneal fractures of 48 patients surgically treated between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups. Preoperative CT, early postoperative and postoperative 1st-year radiographs, and The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score scores were evaluated. Results: According to the Sanders classification, nine patients in the EL group were type 2(36%), 16 patients type 3 (64%), 8 patients in ST group type 234.8%), 13 patients (56.5%) type 3, 2 patients (8.7%) type 4. The mean AOFAS-Hindfoot score was 85(63-100) in the ST group and 83(52-93) in the LE group at one year. Mean preoperative waiting time was shorter, with an average of 2(1-4) days in ST and 6(3-12) days in LE. Conclusion: ST approach shortens the preoperative waiting time in intra-articular calcaneal fracture surgery, provides a sufficient vision for anatomical restoration, and effectively avoids complications.
... Consequently, the waiting time until the surgery in the locking plate group was significantly longer than that in the screw group in our study. However, previous studies have reported that plate fixation via STA can be performed with a shorter waiting time until surgery than ELA [26,27]. Furthermore, in our study, soft tissue complications did not increase in the locking plate group. ...
Background
The optimal treatment of displaced intra-articular calcaneal fractures (DIACF) is controversial. This study compared the fixation stability of screws and locking plates in DIACF treated via the sinus tarsi approach (STA).
Methods
We retrospectively evaluated 118 DIACF cases treated via STA and extracted data that could affect treatment outcomes. Loss of Böhler’s angle after surgery was measured to compare fixation stability.
Results
The loss of Böhler’s angles was significantly smaller in the locking plate group than in the screw group (2.6±2.7º vs. 5.6±5.3º P<0.01). There was no difference in the clinical outcomes between the groups. On multivariate logistic regression analysis, screw fixation was significantly associated with loss of Böhler’s angle by >10º (odds ratio, 8.63; 95% confidence interval, 1.16-64.4; P<0.05).
Conclusions
Locking plate fixation is more reliable than screw fixation for preventing correction loss in DIACF treated via STA.
Level of evidence
III
... More recently, Schepers et al. [23] compared the two approaches by measuring wound complications, operative time, timing of surgery, length of postoperative hospitalization, and restoration of calcaneal anatomy, via data obtained retrospectively from patients with DIACF. The accuracy of the reduction of the posterior facet was evaluated with postoperative CT scans. ...
Calcaneum fractures are debilitating injuries with high complication rates and poor functional outcomes after both operative and non-operative management. The optimal management of such fractures is still highly debated in the literature with conflicting evidence on the preferred management of displaced intra-articular calcaneum fractures (DICAF). This article reviews the current concepts in the management of DIACF.
