A minimally invasive sinus tarsi approach with percutaneous plate and screw fixation for intra-articular calcaneal fractures

Abstract

According to characteristic of anatomical structure of calcaneus and sinus tarsi approach, the minimally invasive plate for treatment of displaced intra-articular calcaneal fractures had been designed. Here we aimed to review the effect of this treatment. Forty intra-articular calcaneal fractures in 38 patients from September 2006 to September 2008 were treated with percutaneous plate via sinus tarsi approach under the monitoring of C-shaped arms. All calcaneal anatomical parameters, including height, width, length, Böhlers angle and Gissane angle were measured by X-ray before and after surgery. Postoperative lateral wound healing was also evaluated and clinical functional outcomes were graded using the Maryland foot score. All patients had been followed up for an average of 12 months ranged from 3 months to 24 months. X-ray indicated satisfactory restoration of the calcaneal height, width, length, Böhlers angle and Gissanes angle. Maryland foot score demonstrated that excellent result was achieved in 32 cases, good in 6 cases, fair in 2 cases, and the excellent and good rate was 95%. Postoperative complications were not found in all fractured feet. Our results suggest that this minimally invasive sinus tarsi approach with new designed plate and screw fixation technique for the treatment of intra-articular calcaneal fractures can not only obtain the satisfactory outcomes, but also can effectively prevent surgical complications.

Minimally invasive (sinus tarsi) approach for calcaneal fractures

“…Nevertheless, the poor visualization of the lateral wall of the calcaneus through this small incision makes it difficult to insert the conventional plate for obtaining a stable fixation. Thus, the development of a plate that is adaptable to the anatomic characteristics of the calcaneus and sinus tarsi approach is important [6, 7]. …”

Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach

“…Xia et al had no wound complications in their series. 8 Kikuchi et al 9 had wound complications in 13.6% of their 22 fractures, but all were managed without surgical intervention. In a systematic review 10 of calcaneal fractures treated through a sinus tarsi approach, wound complications were seen in 0% to 15.4% (average 4.8%) of cases.…”

“…In 2013 Xia et al 8 assessed the outcomes of using the sinus tarsi approach with plate fixation and found an adequate radiographic reduction of calcaneal fractures. Kikuchi et al 9 showed a statistically significant improvement in Bohler's angle, but not in the angle of Gissane in their series of patients treated with fixation through a sinus tarsi approach.…”

“…Most authors [6][7][8]15 only included Sanders II and Sanders III fractures, with only Kikuchi et al 9 including Sanders IV fractures. There was no statistical difference in the adequacy of reduction comparing Sanders II with Sanders III fractures.…”

Towards uniformity in communication and a tailor-made treatment for displaced intra-articular calcaneal fractures

“…These findings are supported by the growing body of evidence on the sinus tarsi approach (PubMed and Google Scholar search). Approximately 17 published series report on the sinus tarsi approach or on a modified sinus tarsi approach [1][2][3][4][5][6][7][8][9][10][11][12][13][14][16][17][18]. These case series involve 491 patients (average 29 per study; range 13-99), with 528 calcaneal fractures (31 average per study; range 13-106).…”