Effect of tourniquet application on postoperative outcomes in sinus tarsi approach for intra-articular calcaneus fractures

Background: The management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem with disappointing results from open reduction internal fixation (ORIF). Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using only screws through a sinus tarsi approach. Methods: A retrospective study of patients who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was used in all cases consisting of only screws; no plates were used. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data were collected including worker’s compensation claims. Plain radiographs were used to characterize injuries and review outcomes. Results: Seventy-nine DIACFs underwent PSTA with a median follow-up of 200 days (n = 69 patients). Median time to weightbearing was 57.5 days postoperatively. Ten fractures were documented as Sanders II, 36 as Sanders III, and 32 as Sanders IV. Sixty-eight fractures (86.1%) achieved fusion on radiographs at a median of 126.5 (range, 54-518) days. Thirty-nine fractures (57.3%) demonstrated radiographic fusion in all 3 predefined locations. Nine of the 14 worker’s compensation patients returned to work within the period of observation. There were 8 complications: 3 requiring a secondary operation. Eleven of 79 fractures treated did not go on to achieve radiographic union. Conclusion: In this retrospective case series, we found that screws-only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach was associated with relatively high rates of return to work and radiographic fusion. Level of Evidence: Level IV, retrospective case series.

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Return to work after surgical treatment for displaced calcaneus fractures treated with a sinus tarsi approach

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00474 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0047

Author(s):

Michael Swords ◽

Ann Simon

Keyword(s):

Surgical Treatment ◽

Return To Work ◽

Weight Bearing ◽

High Energy ◽

High Rate ◽

Prolonged Standing ◽

Sinus Tarsi ◽

Variable Angle ◽

Sinus Tarsi Approach ◽

Calcaneus Fractures

Category: Trauma Introduction/Purpose: Calcaneus fractures most often occur as a result of a high-energy injury in patients of working age. While it is known that patients will require time to recover, the rate of return to work and at what time frame is not well known. The purpose of this registry is to evaluate return to work issues after surgical treatment of a displaced calcaneus fracture treated operatively with plate fixation by a sinus tarsi approach. Methods: Subjects with displaced intra-articular calcaneal fractures surgically treated with a variable angle locking calcaneal plate by a sinus tarsi approach were included in a registry. Descriptive statistics were calculated for demographics, pre-operative, operative and post-operative characteristics. Results: The registry included 27 consecutive patients. According to Sanders classification, nine cases (33.3%) had type II fractures, sixteen cases (59.3%) had type III, and two cases (7.4) had type IV fractures. 23/27 (85%) patients were able to return to work at their pre injury occupation involving prolonged standing. Four (4) of the 23 patients required work restrictions, Return to work occurred at an average of 16.5 weeks from injury (range 9-22 weeks) for individuals with weight bearing occupations. One patient was able to return at 4 weeks to a temporary sit down position. Three (3) patients were unable to return to their prior occupation. Return to work information was unknown for 1 patient. Conclusion: The data demonstrates that patients treated for displaced intra articular calcaneus fractures with a variable angle locking plate by a sinus tarsi approach return to work to standing occupations at a high rate. The return to work data may be used to counsel patients and employers on realistic return to work expectations.

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Acute fixation of displaced intra-articular calcaneus fractures is safe using the sinus tarsi approach

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000002085 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Noah M. Joseph ◽

Alex Benedick ◽

Christopher McMellen ◽

Joshua Napora ◽

Robert Wetzel ◽

...

Keyword(s):

Sinus Tarsi ◽

Sinus Tarsi Approach ◽

Calcaneus Fractures

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Wound and Sural Nerve Complications of the Sinus Tarsi Approach for Calcaneus Fractures

Foot & Ankle International ◽

10.1177/1071100718774808 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1106-1112 ◽

Cited By ~ 8

Author(s):

Shaoliang Li

Keyword(s):

Nerve Injury ◽

Sural Nerve ◽

Iatrogenic Injury ◽

Lateral Malleolus ◽

Wound Complications ◽

Sinus Tarsi ◽

Sinus Tarsi Approach ◽

Group A ◽

Group B ◽

Calcaneus Fractures

Background The purpose of this study was to evaluate the optimal timing and measures of the sinus tarsi approach for calcaneus fractures to avoid iatrogenic injury of the sural nerve and to assess for wound complications. Methods: A case series of 53 patients with calcaneus fractures treated by a single surgeon with the sinus tarsi approach was retrospectively analyzed. On the basis of the delay time from injury to surgery, patients were classified into 4 groups: immediate (0–3 days), early (4–6 days), intermediate (7–14 days), and late (14–18 days). All patients were followed for at least 1 year to observe wound conditions. The rate of wound complications and iatrogenic sural nerve injury was described. Incisions were classified into 2 groups: group A included patients with incisions extending posterior to the lateral malleolus, and group B included patients with incisions confined anterior to the lateral malleolus. The rates of nerve injury were compared between both groups. Forty-three patients with 52 Sanders type II fractures were included. Results: The average time to surgery from injury was 8.8 days (range, 0–18 days). The overall postoperative rate of wound complications was 5.8% (3 of 52). In the immediate group, deep infections and wound necrosis were found in 2 of 8 fractures (25%). In the early group, 1 of 15 fractures developed superficial infection (6.7%). In the intermediate and late groups, no wound complication was identified. Iatrogenic sural nerve injury was recorded in 5 of 52 patients (9.6%). Group A had 33% (4 of 12) nerve injuries and group B had 2.5% (1 of 40) ( P = .009). In 70% of cases, a main branch of the sural nerve was directly under the incision. Conclusions: The sinus tarsi approach was generally effective and safe for calcaneus fractures. However, it was relatively risky to perform open reduction and internal fixation by the sinus tarsi approach within 6 days of injury. Because the sural nerve is in the vicinity of the approach, iatrogenic injury should be avoided by the use of careful planning and meticulous manipulations. Level of Evidence Therapeutic; Level III, comparative study.

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Radiographic and Postoperative Outcomes of Plate Versus Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi

Foot & Ankle International ◽

10.1177/1071100719848063 ◽

2019 ◽

Vol 40 (8) ◽

pp. 929-935 ◽

Cited By ~ 5

Author(s):

Charles C. Pitts ◽

Adam Almaguer ◽

John T. Wilson ◽

Jonathan H. Quade ◽

Michael D. Johnson

Keyword(s):

Cannulated Screw ◽

Wound Complications ◽

Cannulated Screws ◽

Radiographic Outcomes ◽

Sinus Tarsi ◽

Sinus Tarsi Approach ◽

Significant Difference ◽

Group 2 ◽

Calcaneus Fractures ◽

Group 1

Background: Intra-articular fractures of the calcaneus are a common injury to the hindfoot following high-energy trauma to the lower extremity. Treatment of these fractures has evolved. Due to the concern of wound complications associated with extensile open treatment, smaller incision techniques, such as the sinus tarsi approach, are increasing in popularity. A number of fixation strategies are utilized with this approach, and it is unknown which most accurately restores radiographic alignment. The purpose of this study was to compare the postoperative radiographic outcomes of a plate and screw construct versus a cannulated screw construct when using the sinus tarsi approach for open reduction and internal fixation (ORIF) of calcaneus fractures. Methods: After institutional review board approval, records for all patients treated surgically at our institution for calcaneus fractures from 2012 to 2017 were reviewed. Inclusion criteria were intra-articular calcaneus fractures, patients aged 18 years or older, and use of the sinus tarsi approach. Exclusion criteria were open fractures and fractures with less than 6 weeks of postoperative weightbearing, which were excluded for radiographic outcomes. A total of 51 fractures underwent ORIF using cannulated screws alone (group 1), and 23 fractures underwent ORIF using a sinus tarsi plate (group 2). Sixty-one fractures (41 vs 20, respectively) met criteria for radiographic comparison. The primary outcomes of interest included pre- and postoperative Bohler and Gissane angles, wound complications, unplanned return to the operating room (OR), and cost comparison. Results: There was no statistically significant difference between preoperative Bohler angles for group 1 (14.4 degrees) versus group 2 (12.2 degrees) ( P = .44), nor was there a significant difference between postoperative Bohler angles for group 1 (30.1 degrees) versus group 2 (27.1 degrees) ( P = .14). Similarly, preoperative Gissane angles for group 1 (130.5 degrees) and group 2 (133.4 degrees) ( P = .54) and postoperative Gissane angles for group 1 (118.2 degrees) and group 2 (119.8 degrees) ( P = .44) showed no statistically significant difference. There were a total of 3 wound complications in group 1 versus 2 wound complications in group 2 ( P = .66). There was no statistically significant difference in operative duration ( P = .97) or the number of unplanned returns to the OR between the 2 groups ( P = .68). Based on the implants used at this institution, and depending on the number of screws used, the estimated cost range of a plate construct was $1070 to $1235, while the estimated cost range of a cannulated screw construct was $717 to $1264. Conclusion: When comparing the cannulated screw and plate and screw fixation techniques, there was no difference in restoration of the Bohler and Gissane angles. Furthermore, the amount of angular correction achieved by initial reduction showed no statistically significant difference between groups, and the amount of reduction lost between initial and final postoperative radiographs showed no statistically significant difference between groups. With regard to the 2 techniques, there was no statistically significant difference in rates of postoperative complications and return to the OR. Our data suggest that fixation using cannulated screws alone versus sinus tarsi plate provides similar radiographic outcomes and risk of complications. The 2 techniques were also similar in terms of implant costs. Our results indicate that either technique effectively improved radiographic parameters. Level of Evidence: Level III, retrospective comparative study.

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