A Modified Sinus Tarsi Approach for Treatment of Displaced Intra-articular Calcaneal Fractures Sanders type Ⅱ or Ⅲ Compared to Extended Lateral Approach
Abstract Background: We have designed a modified sinus tarsi approach (MSTA) to treat sanders type Ⅱ or Ⅲ intra-articular calcaneal fractures, providing sufficient surgical field exposure and operation space, and significantly reducing the rate of wound complications. We compared the radiologic results, clinical outcomes, and complications of patients operated on via the MSTA and the extended lateral approach (ELA) for treatment of displaced intraarticular calcaneal fractures Sanders type Ⅱ or Ⅲ.Methods: We retrospectively studied the utility of the ELA (32 patients, 34 feet) and the MSTA (33 patients, 36 feet) operated on from January 2013 to January 2018. The average follow-up time of the two groups was 58 months. We assessed the preoperative and final x-rays, clinical outcomes and complications at the last follow-up. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale (VAS).Results: In both groups, the average final width, height, Bohler angle were significantly restored compared with the preoperative width, height, and Bohler. The last follow-up calcaneal length, width, height, Bohler angle, Gissane angle did not differ significantly between the 2 groups. In terms of the clinical outcomes, the average AOFAS score of the ELA group checked to 82.1 points, yielding a 77.8% excellent or good rating, and the average VAS score was 1.76 points. In contrast, the average AOFAS score of the MSTA group checked to 81.0 points, yielding a 79.4% excellent or good rating, and the average VAS score was 1.68 points. There was no significant difference in AOFAS score and VAS score between the 2 groups. The wound-healing complication rate was 2.9% in MSTA group and 22.2% in ELA group (p = .040). 4 cases of sural nerve injury occurred in ELA group, and 2 in MSTA group. 1 cases of peroneal tendon complication only occurred in ELA group.Conclusion: Compared with ELA, MSTA provides similar and favorable radiological and clinical results, and is associated with fewer wound complications. We believe the MSTA is more appropriate in the treatment of Sanders II and III calcaneal intra-articular fractures.