scholarly journals The Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Yunfeng Yang ◽  
Haichao Zhou ◽  
Yun Zhang
Keyword(s):  
Open Reduction ◽  
Lateral Approach ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach ◽  
Hind Foot ◽  
Approach Group ◽  
Varus Angle

Category: Hindfoot Introduction/Purpose: To study and compare the clinical outcomes of open reduction and internal fixation via extensile L-shape incision and limited open reduction via sinus tarsi approach using medial distraction technique for intra-articular calcaneal fractures. Methods: We performed a retrospective review of 65 intra-articular calcaneal fractures treated operatively between March 2012 and February 2015, including 32 cases of Sanders type? and 33 of Sanders type?. There were 49 men and 16 women. The mean age was 43.7 years old. They were divided into two groups: sinus tarsi approach group and extensile lateral approach group. No significant difference was found in gender, age, injury pattern, fracture classification between two groups (P>0.05). The Böhler angle, Gissane angle and calcaneal varus angle were measured before surgery, 1 week after surgery and at each follow-up visit respectively. The postoperative function was evaluated by the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS). Results: All of the fractures were healed at about 10 weeks postoperatively. Böhler angle, Gissane angle and calcaneal varus angle were restored obviously, while there was no significant statistically difference between the two groups. Only the corrected value of calcaneal varus angle is statistically significant.At the last follow-up, the average AOFAS ankle and hind-foot score of minimal group was 88.4±6.6, and the VAS score was 1.9±0.7, while of extensile lateral approach group was 83.2±5.6 and 2.3±1.0 respectively. Conclusion: Limited open reduction via sinus tarsi approach for intra-articular calcaneal fractures could reduce the incidence of wound complications effectively, and the medial distraction technique is helpful to correct the calcaneus varus deformity.

scholarly journals Sinus Tarsi Approach for Open Treatment and Internal Fixation of Displaced Intra-articular Calcaneal Fractures in High-Risk Patients: The New Gold Standard?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
James P. Davies ◽  
W. Bret Smith ◽  
Steven Steinlauf ◽  
Mary Millikin
Keyword(s):  
High Risk ◽  
Gold Standard ◽  
Wound Complication ◽  
Lateral Approach ◽  
Wound Complications ◽  
Complication Rates ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach

Category: Ankle, Diabetes, Hindfoot, Trauma Introduction/Purpose: Intra-articular calcaneal fractures offer unique challenges. Wound problems and infection are significant complications in the surgical treatment of calcaneal fractures which in turn can be debilitating to patients and outcomes. The literature suggests varying wound complication rates but 21% up to 33% using the traditional extensile lateral approach in some studies. The extensile lateral approach has historically been accepted as the gold standard for fixation and treatment of these fractures. Recently there has been resurgent interest in alternative approaches to the fixation of intra-articular calcaneal fractures. Of interest is the potential of the sinus tarsi approach to decrease wound complications while having comparable reduction quality to the higher wound risk extensile lateral approach. Methods: A multi-center retrospective chart review study was implemented. The study objective was to review wound complication of the sinus tarsi approach compared with outcomes from the traditional extensile approach for fixation of displaced intra-articular calcaneal fractures. Specifically; examining a population of patients considered at high risk for wound issues, comparing radiographic and clinical outcomes. Results: In the high-risk group, only one primary complications resulted, including one patient with a history of an open fracture. All fractures healed with adequate maintenance of alignment. Chi- squared analysis resulted in a statistically significant difference in complication rates between sinus tarsi and the traditional extensile lateral approach at the 95% confidence level. Conclusion: In both high-risk and lower-risk cohorts of patients, a low rate of infection and wound problems was encountered. A limited approach through a sinus tarsi incision provides a viable option to treat displaced intra-articular calcaneus fracture patients with risk factors for wound issues. The patients all healed both their soft tissue wounds and fractures. Functional return was consistent with other study populations. Our study adds another cohort of patient data demonstrating the advantage of the sinus tarsi approach when compared to the extensile lateral in terms of decreased wound complications while maintaining quality of reductions and clinical outcomes.

scholarly journals Sinus tarsi approach vs. extensile lateral approach for intra-articular calcaneal fracture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0028
Author(s):  
Methee Khongphaophong
Keyword(s):  
Hospital Stay ◽  
Open Reduction ◽  
Operative Time ◽  
Locking Plate ◽  
Calcaneal Fracture ◽  
Lateral Approach ◽  
Wound Complications ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach

Category: Trauma Introduction/Purpose: The options of operative treatment for intra-articular calcaneal fracture still remains controversial. Extensile lateral approach allow excellent exposure to fracture, but bring high rate of wound complications. The aim of this study was to compare the outcome of intra-articular calcaneal fracture treated with open reduction and internal fixation via an extensile lateral versus. Sinus tarsi approach Methods: Prospective study of 62 intra-articular calcaneal fractures treated by open reduction and internal fixation between 2014, October to 2017, June. 29 were treated with extensile lateral approach with calcaneal locking plate(Wright medical, Tennessee), 33 sinus tarsi approach(4 cases need additional mini medial incision approaches for SanderIII AC, BC) with mini-calcaneal locking plate(Normed, Florida). Durations until operation, operative time, foot functional index(total score), visual analog scale, SF-36, Bohler’s angle, angle of Gissane, wound complications and duration of hospital stay were recorded post-operatively and minimal 6 months follow up. Results: Compared 2 groups with demographic datas.Average duration until operation; extensile group was 13.32 days, sinus tarsi group was 6.08 days, p <0.001. Operative time; extensile group was 123.41minutes vs. sinus tarsi group was 91.20 minutes, p <0.001. Wound complications was 24.13% in extensile group vs. 6.06% in sinus tarsi group, p =0.045, Duration of post-operative admission was 6.68 days in extensile group vs. 3.10 days in sinus tarsi group p <0.001 FFI last visits was 25.36 in extensile group vs. 25.65 in sinus tarsi group, p =0.969, VAS activity was 29.68 in extensile group vs. 28.54 in sinus tarsi group, p=0.271. Conclusion: Sinus tarsi approach with mini-calcaneal locking plate was a great option for treatment of intra-articular calcaneal fracture. This approach brought lower rate of wound complications, earlier operations, shorter operation times and shorter hospital stay compared to extensile lateral approach.

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.

scholarly journals Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091528 ◽  
Author(s):  
Tao Yu ◽  
Yuan Xiong ◽  
Alex Kang ◽  
Haichao Zhou ◽  
Wenbao He ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lateral Approach ◽  
Cochrane Library ◽  
Wound Complications ◽  
Complication Rates ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach ◽  
Meta Analyses

Purpose: Accumulated literature has reported the comparative efficacy of the sinus tarsi approach (STA) and the extensile lateral approach (ELA) for the treatment of calcaneal fractures (CFs). However, the best alternative treatment for CF is still inconsistent. Herein, the present systematic review of overlapping meta-analyses aims to achieve an evident conclusion by performing a comprehensive reanalysis of previous meta-analyses regarding the comparison of the STA and the ELA. Methods: We searched several databases, including Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov , OVID, and CNKI for the meta-analyses comparing the STA and the ELA for the treatment of CF. All related meta-analyses of randomized controlled trials and cohort studies were included. Two researchers independently assessed the quality of the articles and extracted the data. The Jadad decision algorithm was used to evaluate the evidence of the articles. Results: Ultimately, five meta-analyses were included in the present study. The Assessment of Multiple Systematic Reviews scores of these articles ranged from 5 to 9 with a median of 7. The analysis of best quality, Bai 2018, was selected based on the Jadad algorithm. In this article, the significant differences were found in wound complications and operating time, recovery of Böhler’s angle, the American Orthopaedic Foot and Ankle Society scores, and the visual analog scale. Conclusion: The clinical relevance of the present study is that both the STA and the ELA are effective in alleviating pain and improving functionality in the treatment of CF. However, due to a shorter operation duration and lower complication rates, the STA was indicated to be a superior alternative for CF treatment.

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.

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