Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures

Abstract

Background: This study sought to assess and compare the clinical efficacy and complications of a modified sinus tarsi approach (MSTA) and the extensile lateral approach (ELA) in the treatment of displaced intraarticular calcaneal fractures. Methods: This retrospective study enrolled 108 patients (117 feet) with Sanders II-IV calcaneal fractures, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The functional and radiological results of the affected feet were analysed retrospectively. Functional evaluation included American Orthopaedic Foot and Ankle Society (AOFAS), visual analog scale (VAS), and Short Form-36 Health Survey (SF-36). Radiological evaluation included preoperative and postoperative changes in the Bohler Angle, Gissane Angle, length, width, and height of the calcaneus. The postoperative complications were also collected and analysed. The independent-samples t-test and analysis of variance (ANOVA)were employed to compare differences between the two groups. Differences within the same group were compared by paired Student's t-test, and categorical variables were compared using the chi-square test. Results:The postoperative functional and radiological results showed that the mean AOFAS, VAS and physical component summary of SF-36 scores in the MSTA group were higher than those in the ELA group (P<0.05). After surgery, the Bohler and Gissane angles were significantly improved in both groups, as were the length, width, and height of the calcaneus; no statistically significant differences existed between the two groups. The incidences of wound healing complications and postoperative sural nerve injury were lower in the MSTA group than in the ELA group (P<0.000). Conclusions:The MSTA can achieve similar effects to the ELA in terms of anatomical reconstruction and functional recovery. It also can also effectively reduce the incidences of wound healing complications and postoperative sural nerve injury, and shorten the length of hospital stay.

Eklem İçi Kalkaneus Kırıklarında Sinus Tarsi ve Ekstensil Lateral Yaklaşımın Karşılaştırılması

“…A literature review examining calcaneus fractures report that there are generally more wound site problems in patient groups operated with the EL approach compared to the ST approach. Ma et al (15) found the complication rate related to wound healing to be 14.75% in the EL approach and 5.36% in the ST approach, and they reported that the difference was statistically significant. Lin et al (20) found that the wound infection rate was higher in Sanders type IV fractures, which were 34.04% in the EL approach and 14.28% in the ST approach.…”

“…On the other hand, Kwon et al (27) found that postponing surgery did not reduce the wound complication rates when the EL approach was used, while the wound complication rate increased when minimally invasive approaches were used. Ma et al (15) reported that the patients in the ST group had a significantly shorter waiting time from injury to surgery than the EL group and that the wound site problem was less in the ST group. They stated that this resulted in a shorter hospital stay and lower costs in the ST group.…”

“…The American Orthopedic Foot and Ankle Association ankle-posterior foot score was used to evaluate the function in the postoperative period (15). A visual analog score was used to evaluate pre-and postoperative pain scores.…”

“…Various minimally invasive techniques, including mini-incision technique, percutaneous fixation, and arthroscopic assisted fixation, have been reported to reduce the risk of complications (8,14). With the ST approach, one of these techniques, in addition to providing joint restoration by directly seeing the subtalar joint, a rigid fracture fixation can be provided without causing soft tissue damage (15). In recent years, comparative studies have become popular with the application of the ST approach in calcaneal fracture surgery (6,8,16).…”

Two and three-dimensional CT mapping of the sustentacular fragment in intra-articular calcaneal fractures

“…The sustentaculum tali are essential in maintaining the internal foot column, so conservative treatment may not be appropriate for displaced sustentacular fractures. Although the extensile lateral approach and tarsal sinus approach are most commonly employed for the operational treatment of calcaneal fractures [17][18][19][20] , the tarsal sinus method is gaining popularity [17][18][19][20] . One downside of this isolated lateral incision is that the sustentacular fragments cannot be managed directly, and the visualization of the sustentacular fragments is limited.…”