Anatomical Study of Sinus Tarsi–Based Lateral Lengthening Calcaneal Osteotomy

2021 ◽  
pp. 107110072110413
Author(s):  
Matthias Aurich ◽  
Mark Lenz ◽  
Gunther O. Hofmann ◽  
Wiebke Schubert ◽  
Matthias Knobe ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Lateral Approach ◽  
Lateral Sinus ◽  
Level Of Evidence ◽  
Sinus Tarsi ◽  
Calcaneal Osteotomy ◽  
Level Ii ◽  
Sinus Tarsi Approach ◽  
Potential Damage ◽  
Extended Lateral Approach

Background: Lateral lengthening calcaneal osteotomy (LL-CO) is commonly performed as a treatment for an abducted midfoot in pes planovalgus deformity. The purpose of this study is to investigate potential damage to medial structures with a sinus tarsi LL-CO. Methods: Sixteen cadaver feet were used. Eight feet had an extended lateral approach, and 8 had a limited lateral (sinus tarsi) approach. All underwent a sinus tarsi LL-CO. Specimens were then dissected to identify inadvertent injury to medial structures. Results: Sinus tarsi LL-CO was associated with damage to the sustentaculum tali and medial articular facets in 56% and 62.5% of specimens, respectively. No anterior or posterior facet injuries were found, although 56% of specimens had a confluent medial and anterior facet. Conclusion: Damage to the medial articular facet and sustentaculum is possible with a flat cut sinus tarsi LL-CO due to the curved nature of the relevant sinus tarsi and canal anatomy. Clinical Relevance: Sinus tarsi LL-CO needs to be performed with caution since damage to the subtalar joint is possible. Level of Evidence: Level II, prospective cohort study.

scholarly journals Use of the Extended Sinus Tarsi Approach for Treatment of Displaced Intra-articular Calcaneal Fractures Compared with the Extended Lateral Approach

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0027
Author(s):  
Chan Kang ◽  
Dong Yeol Kim ◽  
Jae-Hwang Song ◽  
Jeong-kil Lee ◽  
Seokhwan Song ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Lateral Approach ◽  
Wound Complications ◽  
Pain Patient ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Patient Reported ◽  
Extended Lateral Approach

Category: Trauma Introduction/Purpose: We compared the radiographic results and clinical outcomes of patients with displaced, intra-articular calcaneal fractures treated via the extended sinus tarsi approach (ESTA) and the extended lateral approach (ELA). Methods: We retrospectively studied the utility of the ELA (46 patients, 52 feet) and the ESTA (56 patients, 64 feet) in patients operated upon between January 2009 and September 2014. We evaluated pre- and post-operative X-rays and computed tomography (CT) data. Pain, patient-reported functional outcomes, patient satisfaction, and postoperative complications, were investigated at the three year follow-up. Results: Neither the postoperative nor three year follow-up Böhler angles, nor the calcaneal width, differed significantly between the two groups (both p > 0.05). The maximum step-off of the posterior facet on the three month CT follow-up of the ESTA was significantly less than that of the ELA (p < 0.05). We found no significant between-group differences in terms of postoperative translation (p = 0.232) or angulation of the sustentacular fragment (p = 0.132), three year follow-up mean visual analog scale pain score at rest (p = 0.641) or during weight-bearing (p = 0.525), Foot Function Index (FFI) (p = 0.712), and self-reported satisfaction (p = 0.823). The ELA experienced significantly more wound complications (p = 0.039) and nonunions (p = 0.014) than the ESTA. Conclusion: Compared with the ELA, the ESTA afforded comparable radiological results and clinical outcomes, associated with a reduced operative time and fewer wound complications and nonunions. We suggest that the ESTA is an efficient surgical option when treating displaced, intra-articular calcaneal fractures.

Extended Sinus Tarsi Approach for Treatment of Displaced Intraarticular Calcaneal Fractures Compared to Extended Lateral Approach

2018 ◽  
Vol 40 (2) ◽  
pp. 167-177 ◽  
Author(s):  
Jae Hwang Song ◽  
Chan Kang ◽  
Deuk Soo Hwang ◽  
Dong Hun Kang ◽  
June Woo Park
Keyword(s):  
Clinical Outcomes ◽  
Lateral Approach ◽  
Wound Complications ◽  
Pain Patient ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Patient Reported ◽  
Extended Lateral Approach

Background: We compared the radiographic results and clinical outcomes of patients operated on via the extended sinus tarsi approach (ESTA) and the extended lateral approach (ELA) for treatment of displaced intraarticular calcaneal fractures. Methods: We retrospectively studied the utility of the ELA (46 patients, 52 feet) and the ESTA (56 patients, 64 feet) in patients operated on between January 2009 and March 2015. We evaluated pre- and postoperative x-rays and computed tomography (CT) data. Pain, patient-reported functional outcomes, satisfaction, and postoperative complications were investigated at the 3-year follow-up. Results: Neither the postoperative nor 3-year follow-up Böhler angles, nor the calcaneal width, differed significantly between the 2 groups (both P > .05). However, the maximum step-off of the posterior facet on the 3-month CT follow-up of the ESTA group was significantly less than that of the ELA group ( P < .05). We found no significant between-group differences in terms of postoperative translation ( P = .232) or angulation ( P = .132) of the sustentacular fragment on the 3-month CT follow-up. At the 3-year follow-up, we found no significant between-group difference in the mean visual analog scale pain score at rest ( P = .641) or during weightbearing ( P = .525). We found no significant between-group difference in the Foot Function Index (FFI) ( P = .712) or self-reported satisfaction ( P = .823). The ELA group experienced significantly more wound complications ( P = .041) and nonunions ( P = .041) than the ESTA group. Four instances of superficial peroneal nerve injury were reported in the ESTA group ( P = .127). Conclusion: Compared with the ELA, the ESTA afforded comparable, favorable radiological results and clinical outcomes, associated with fewer wound complications and nonunions. We suggest that the ESTA is an effective operative option when treating displaced, intraarticular calcaneal fractures. Level of Evidence: Level III, comparative study.

scholarly journals Lateral Calcaneal Artery: Pertinent Anatomy for Sinus Tarsi Approach and Calcaneal Osteotomy

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0020
Author(s):  
Karl J Henrikson ◽  
Umur Aydogan
Keyword(s):  
Lateral Approach ◽  
Screw Placement ◽  
Wound Complications ◽  
Artery Injury ◽  
Sinus Tarsi ◽  
Calcaneal Osteotomy ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach ◽  
Relationship Of ◽  
The Relationship

Category: Trauma Introduction/Purpose: The lateral calcaneal artery provides critical arterial supply for healing of the extensile lateral approach to the calcaneus. A recent study has shown that preoperative doppler ultrasound showing non-patency of the lateral calcaneal artery is strongly correlated with wound complications when using this approach. Plate and screw fixation of calcaneus fractures through the sinus tarsi approach has gained popularity, including techniques involving percutaneous screw placement into a plate. Avoidance of lateral calcaneal artery injury may be improved with further quantification of its anatomy and associated variation. Finally, while the lateral approach to the calcaneus for osteotomy is routinely performed with minimal wound complications, the relationship of the lateral calcaneal artery to this approach was studied as well. Methods: This is a cadaveric anatomic study performed using six fresh frozen cadaver specimens. The specimens were treated with intra-arterial injection of latex and dye. The specimens were first utilized in a separate study in which an orthopedic resident, blinded to the present study, performed a standard, oblique osteotomy of the calcaneal body. The cadavers were then examined for the relationship of the lateral calcaneal artery to the previous dissections. Finally, an extended sinus tarsi approach was made, and the relationship of the lateral calcaneal artery was quantified relative to the posterior facet and the posterior most point of the tuberosity, and relative to screw holes in a percutaneous calcaneal plate. Results: Lateral calcaneal artery injury was observed in six out of six cadavers in which calcaneal osteotomy had been performed. The lateral calcaneal artery was encountered when performing the extended sinus tarsi approach at a mean ratio of 0.4 (standard deviation 0.11) of the distance from the posterior facet to the posterior aspect of the tuberosity. It crossed the posterior-most hole in the posterior facet portion of the plate in two cadavers. It also passed within 2 mm of the posterior most hole in the tuberosity portion of the plate in one cadaver. Conclusion: Careful dissection is warranted when extending the sinus tarsi approach beyond the posterior facet to preserve the lateral calcaneal artery. Injury is also possible with percutaneous tuberosity screw placement into a plate, and the consequences for sinus tarsi approach healing are unknown. Lateral calcaneal artery injury is difficult to avoid with the traditional lateral approach for calcaneal osteotomy, and while it has no implications for that approach which heals reliably, it indicates that preoperative doppler would be warranted if extensile lateral approach were considered in a patient who has previously undergone calcaneal osteotomy.

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