Fixation of displaced intra-articular calcaneus fractures is safe using either sinus tarsi or extensile lateral approach

Joseph, Noah M; Sinkler, Margaret A.; Magister, Steven; Bacharach, Abigail; Pang, Aaron; Boes, Kirsten; Vallier, Heather A.; Hirschfeld, Adam G.; Ochenjele, George

doi:10.1016/j.injury.2023.02.036

Cited by 3 publications

(4 citation statements)

References 32 publications

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“…14 Other studies have reported lower risks of complications with surgical intervention, which may in turn be related to institutional fracture load and higher surgeon volumes. 18,31,44 We found a greater risk of wound complications after surgery; however, the rates of subtalar arthrodesis for the development of subtalar arthritis was significantly greater after nonoperative treatment, which is in line with a recent Cochrane review. 6 Our experience is that the sinus tarsi approach still carries risks of wound complications and patients should be informed regarding this.…”

Section: Discussionsupporting

confidence: 86%

“…16 There is evidence that shows that reduction of fracture and surgeon/institutional fracture volume is linked to longer-term outcomes, and this is important when considering surgical intervention. 1,18,31,44 Because of wound complications associated with the extended lateral approach, many surgeons have moved to a sinus tarsi approach, which is associated with equivalent quality of reduction and potentially associated with fewer wound complications, greater functional outcomes, and lower complication rates. 25,41,42 Some surgeons argue that primary surgical intervention is warranted in order to try to reduce late complications associated with nonoperative management which includes pain, functional limitations, and secondary arthritis (many of which require late surgical intervention such as arthrodesis for treatment).…”

Section: Background/rationalementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive Surgery vs Nonoperative Treatment for Displaced Intraarticular Calcaneal Fracture: A Prospective Propensity Score Matched Cohort Study With 2-Year Follow-up

Ahluwalia,

Lewis,

Musbahi

et al. 2024

Foot Ankle Int.

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Background: Optimal management of displaced intraarticular calcaneal fractures remains controversial. The aim of this prospective cohort study was to compare the clinical and radiologic outcomes of minimally invasive surgery vs nonoperative treatment in displaced intraarticular calcaneal fracture up to 2 years. Methods: All displaced intraarticular calcaneal fractures between August 2014 and January 2019 that presented to a level 1 trauma center were considered for inclusion. The decision to treat was made by a multidisciplinary team consisting of fellowship-trained orthopaedic surgeons. Operative treatment protocol involved sinus tarsi approach or percutaneous reduction and internal fixation. Nonoperative protocol involved symptomatic management with no attempt at closed reduction. The Manchester-Oxford Foot Questionnaire (MOXFQ) and EuroQol–5 Dimensions–5 Level (EQ-5D-5L) patient-reported outcome measures were used to assess foot and ankle and general health related quality of life outcomes, respectively, at 2-year follow-up. Radiographic assessment was performed based on preinjury and 12-week postinjury radiographs. Results: A total of 101 patients were included for analysis between August 2014 and January 2019. We propensity score matched 46 patients in the surgical cohort to 46 patients in the nonsurgical cohort. At 24 months, there was no significant difference in the MOXFQ Index score ( P > .05); however, the surgical cohort had a significantly higher EQ-5D-5L Index score ( P < .05) and return to work (91% vs 72%, P < .05) and physical activity rate (46 vs 35%, P < .05) despite a higher proportion of more complex fractures in the surgical cohort. The wound complication rate following surgery was 16%. In addition, 14% of patients in the nonoperative cohort subsequently underwent arthrodesis compared with none of the patients in the surgical cohort. Conclusion: In this study, we found that operative treatments were associated with low rates of surgical complication at 2 years and long-term pain improvement, facilitating earlier and better functional outcomes for complex injury patterns compared with nonoperative treatment for less severe fractures. Level of Evidence: Level III, retrospective cohort.

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Section: Discussionsupporting

confidence: 86%

Section: Background/rationalementioning

confidence: 99%

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Minimally Invasive Surgery vs Nonoperative Treatment for Displaced Intraarticular Calcaneal Fracture: A Prospective Propensity Score Matched Cohort Study With 2-Year Follow-up

Ahluwalia,

Lewis,

Musbahi

et al. 2024

Foot Ankle Int.

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“…Furthermore, this study controlled for age and BMI, both of which are associated with risk of reoperation in DIACF. 15 For the reduction quality regressions, Sanders classification was also included as covariate. Binary logistic regression was used to assess the association of surgeon experience (both years and cumulative cases) with clinical dichotomous outcomes, multiple linear regression was used to assess the relationship between surgeon experience with continuous reduction quality outcomes, and multinomial logistic regression was used to assess how surgeon experience is associated with the reduction quality grade comparisons.…”

Section: Introductionmentioning

confidence: 99%

Surgeon Learning Curve for the Sinus Tarsi Approach to Intra-articular Calcaneus Fractures – Improvement with Experience

Joseph

McCaskey

Bhatt

et al. 2023

Journal of Orthopaedic Trauma

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Objective: To analyze the relationship between surgeon experience with the sinus tarsi approach (STA) and outcomes in the treatment of displaced intra-articular calcaneus fractures (DIACF). Setting: Single level 1 trauma center Design: Retrospective. Patients/Participants: 103 consecutive DIACF (OTA/AO 82C; Sanders II-IV) treated operatively using STA from 2015 to 2021. Intervention: Open management using the STA performed by two fellowship-trained orthopaedic traumatologists. Main Outcome Measurement: Quality of anatomic reduction based on postoperative CT scans and standard radiographs. Results: Sixty-six patients met inclusion criteria. Patients were primarily men (75.8%) with mean age 41 years (range 20-71 years), including 14 smokers (21.2%), 9 diabetics (13.6%), and 10 open fractures (15.2%). Sanders III fractures were most common (68.2% vs 28.5% and 6.1% Sanders II/IV respectively). Reduction quality was predominantly Good (59.1%, n=39) or Excellent (25.8%, n=17). Complications included wound necrosis (1), superficial infection (1), deep infection (1), and symptomatic posttraumatic arthritis requiring arthrodesis (3). There was a 29.3% reduction in likelihood of surgical complication with each year in surgeon experience with the STA and an 8.9% reduction per case (p<0.001). The likelihood of achieving a Good or Excellent reduction was 1.8 and 2.3 times greater than achieving a Fair reduction, respectively, for each year increase in surgeon experience with the STA (p=0.012 and 0.007, respectively). For each successive case, there was a 1.2 times greater likelihood of achieving a Good reduction (p=0.03). Conclusion: Surgeon experience plays a critical role in outcomes. We found that outcomes (reduction, complications) improve with each cumulative case and year of experience with the STA to treat DIACF. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Primary subtalar arthrodesis with percutaneous screw fixation and bone grafting through mini-open sinus tarsi approach for sanders type IV bilateral calcaneal fracture - three-year follow-up case report

Jovanovic,

Miceta,

Jovanovic

et al. 2024

Srp Arh Celok Lek

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Introduction. Calcaneus fractures are rare but potentially debilitating injuries. Most of them are displaced intraarticular fractures, which management represents one of the controversial issues. There is no consensus on whether to operate or not. The most often chosen surgical treatment is open reduction and internal fixation as the primary method. Failure of this surgery often needs secondary subtalar arthrodesis as definitive management, so primary subtalar arthrodesis in cases with severe comminution represents definitive treatment in one stage with good functional results. Case outline. We present the case of a 54-year-old male patient with a severely comminuted (Sanders type IV) bilateral calcaneus fracture. After the withdrawal of local swelling and disappearance of fracture blisters patient was operated on using one-stage bilateral subtalar arthrodesis with percutaneous screw fixation and bone grafting performed through a mini-open sinus tarsi approach. The early postoperative period went unremarkably. The patient did not walk for the first seven postoperative weeks, after which rehabilitation was continued with partial weight bearing with a gradual increase of weight-bearing to full through the next five weeks, after which walking aids were completely phased out. Three years after surgery patient has no symptoms and has a close-to-normal gait. Conclusion. Although this type of injury has traditionally been treated with open reduction and internal fixation, we believe that primary subtalar arthrodesis with bone grafting through a mini-open sinus tarsi approach can benefit patients with severe comminution of calcaneus, allowing good functional results and patient satisfaction, with fewer postoperative complications and faster definitive recovery.

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Fixation of displaced intra-articular calcaneus fractures is safe using either sinus tarsi or extensile lateral approach

Cited by 3 publications

References 32 publications

Minimally Invasive Surgery vs Nonoperative Treatment for Displaced Intraarticular Calcaneal Fracture: A Prospective Propensity Score Matched Cohort Study With 2-Year Follow-up

Minimally Invasive Surgery vs Nonoperative Treatment for Displaced Intraarticular Calcaneal Fracture: A Prospective Propensity Score Matched Cohort Study With 2-Year Follow-up

Surgeon Learning Curve for the Sinus Tarsi Approach to Intra-articular Calcaneus Fractures – Improvement with Experience

Primary subtalar arthrodesis with percutaneous screw fixation and bone grafting through mini-open sinus tarsi approach for sanders type IV bilateral calcaneal fracture - three-year follow-up case report

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