Role of Subtalar Arthroscopy in Operative Treatment of Sanders Type 2 Calcaneal Fractures Using a Sinus Tarsi Approach

2018 ◽  
Vol 39 (4) ◽  
pp. 443-449 ◽  
Author(s):  
Chul Hyun Park ◽  
Doo Hyung Yoon
Keyword(s):  
Operative Treatment ◽  
Short Form ◽  
Clinical Results ◽  
Calcaneal Fractures ◽  
Level Of Evidence ◽  
Sinus Tarsi ◽  
Intraoperative Fluoroscopy ◽  
Sinus Tarsi Approach ◽  
Good Grade

Background: This study was conducted to evaluate the usefulness of subtalar arthroscopy in the operative treatment of Sanders type 2 calcaneus fractures using a sinus tarsi approach. Methods: Forty-six Sanders type 2 calcaneal fractures were consecutively treated using a sinus tarsi approach. Intraoperative fluoroscopy was used to evaluate fracture reduction in the first 23 patients (fluoroscopy group), and intraoperative fluoroscopy and subtalar arthroscopy were used in the latter 23 patients (arthroscopy group). Clinical evaluations were performed using a visual analog scale, the Ankle-Hindfoot Scale developed by the American Orthopaedic Foot & Ankle Society, and Short Form Health Survey. Radiographic evaluations were performed using calcaneal and lateral radiographs and computed tomography (CT) scans. Böhler’s angles and calcaneal widths were compared between the groups. Reduction of the posterior facet was graded according to articular step, defect, and angulation of the posterior facet on CT. Results: At the last follow-up, clinical results as well as Böhler’s angles and calcaneal widths were not different between the groups. On immediately postoperative CT, reduction of the posterior facet showed a higher-than-good grade in 17 feet (73.9%) in the fluoroscopy group and a higher-than-good grade in 22 feet (95.7%) in the arthroscopy group, and these values were significantly different between the groups ( P = .04). Conclusion: A combined approach using fluoroscopy and subtalar arthroscopy showed better reduction of the posterior facet on CT than using fluoroscopy alone. Therefore, subtalar arthroscopy could be a useful method for detecting joint incongruence when using the sinus tarsi approach for Sanders type 2 calcaneal fractures. Level of Evidence: Level III, comparative series.

Randomized comparative study between extensile lateral and sinus tarsi approaches for the treatment of Sanders type 2 calcaneal fracture

2021 ◽  
pp. 1-8
Author(s):  
Chul Hyun Park ◽  
Hongfei Yan ◽  
Jeongjin Park
Keyword(s):  
Comparative Study ◽  
Subtalar Joint ◽  
Short Form ◽  
Operation Time ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Aofas Score ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

Aims No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. Methods Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of movement (ROM), Böhler’s angle and calcaneal width, and posterior facet reduction. Results Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). Conclusion The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant.

scholarly journals The Usefullness of Subtalar Arthroscopy in Surgical Treatment of Sanders Type 2 Calcaneal Fractures Using a Sinus Tarsi Approach

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Chul-Hyun Park ◽  
Dong-Il Chun ◽  
Hongjoon Choi ◽  
Jaeho Cho ◽  
JAEWOO PARK
Keyword(s):  
Short Form ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sf 36 ◽  
Intraoperative Fluoroscopy ◽  
Sinus Tarsi Approach ◽  
Significant Difference ◽  
American Orthopaedic ◽  
Clinical And Radiological Results

Category: Ankle, Trauma Introduction/Purpose: The sinus tarsi approach was designed to provide a direct view of the posterior facet and reduce soft tissue and neurovascular injuries. However, it is difficult to expose posterior facet using sinus tarsi approach because of limited surgical view. Confirmation of reduction status in intra-articular calcaneal fractures has traditionally been performed by intraoperative fluoroscopy such as Brodens view. Recently some reports indicate that there is a role for subtalar arthroscopy in these fractures. We thought that combination of intraoperative fluoroscopy and subtalar arthroscopy could more accurately restore joint congruity and provide better clinical outcomes. The purpose of this study was to clarify whether this combined checking has better clinical and radiological results comparing with intraoperative fluoroscopy only. Methods: Forty-five displaced calcaneal fractures involving the posterior facet were consecutively treated using a sinus tarsi approach by a single surgeon. Among them, 25 fractures were confirmed reduction of posterior facet by fluoroscopy (Fluoroscopy group) and 20 fractures were confirmed by combined fluoroscopy and subtalar arthroscopy (Arthroscopy group). Clinical evaluations were performed using the visual analogue scale (VAS) and the Ankle-Hindfoot Scale developed by the American Orthopaedic Foot and Ankle Society (AOFAS), and short form (SF)-36 v2 questionnaires. Radiographic evaluations were performed using calcaneal lateral radiographs and CT. Changes in Böhler’s angle were evaluated from the preoperative and last follow-up lateral radiograph of calcaneus. Reduction of the posterior facet was graded according to articular step, defect, and angulation of the posterior facet in CT. Results: There were no significant differences in terms of VAS, AOFAS score, and SF-36 v2 between Fluoroscopy and Arthroscopy groups at the last follow-up. No significant difference was observed in change of Böhler’s angles between the groups. Reduction of the posterior facet was graded excellent in 5 feet (20%), good in 12 (48%), and fair in 8 (32%) in Fluoroscopy group and excellent in 7 feet (35%), good in 11 (55%), and fair in 2 (10%) in Arthroscopy on postoperative CT. Screw penetration of posterior facet were observed in 4 feet of Fluoroscopy group and 1 foot of Arthroscopy group on postoperative CT. Conclusion: Subtalar arthroscopy appears to be useful in detecting joint incongrucencies in sinus tarsi approach of intra-articular calcaneal fractures.

Radiographic and clinical results of modified 2-incision sinus tarsi approach for treatment of calcaneus fracture

Injury ◽  
2021 ◽  
Author(s):  
Chien-Shun Wang ◽  
Yun-Hsuan Tzeng ◽  
Tzu-Cheng Yang ◽  
Chun-Cheng Lin ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Clinical Results ◽  
Calcaneus Fracture ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

scholarly journals Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Cyrus Rashid Mehta ◽  
Vincent V. G. An ◽  
Kevin Phan ◽  
Brahman Sivakumar ◽  
Andrew J. Kanawati ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

scholarly journals Minimally invasive (sinus tarsi) approach for calcaneal fractures

2016 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhe Wang ◽  
Xiu Hui Wang ◽  
Sheng Long Li ◽  
Xin Tang ◽  
Bei Gang Fu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

Screws-Only Primary Subtalar Arthrodesis for Calcaneus Fractures

2022 ◽  
pp. 107110072110586
Author(s):  
Ainsley K. Bloomer ◽  
R. Randall McKnight ◽  
Nicholas R. Johnson ◽  
David M. Macknet ◽  
Meghan K. Wally ◽  
...  
Keyword(s):  
Case Series ◽  
Retrospective Case ◽  
Worker's Compensation ◽  
Level Of Evidence ◽  
Worker’S Compensation ◽  
Subtalar Arthrodesis ◽  
Sinus Tarsi ◽  
Retrospective Case Series ◽  
Sinus Tarsi Approach ◽  
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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