Surgical Treatment of Sanders Type 2 Calcaneal Fractures Using a Sinus Tarsi Approach

Abstract

Background:Calcaneum is the most commonly fractured tarsal bone. The optimal treatment for displaced calcaneus fractures involving the posterior facet is surgical. The extensile lateral approach is commonly preferred because it provides sufficient exposure of the subtalar facet. However, this technique has the risk of complications such as wound necrosis and sural nerve injury. Various minimally invasive approaches, such as sinus tarsi approach, limited posterior approach, and percutaneous approach, have been introduced to reduce possible complications. This study was prospectively performed to evaluate the results of the sinus tarsi approach for Sanders Type 2 calcaneal fractures using postoperative computed tomography (CT).Materials and Methods:Between October 2012 and December 2013, 20 Sanders Type 2 calcaneal fractures were consecutively treated using a sinus tarsi approach and checked using CT preoperatively, immediately postoperatively, and at 12 months after surgery. Clinical evaluations were performed using the visual analog scale (VAS) and the ankle-hindfoot score developed by the American Orthopaedic Foot and Ankle Society (AOFAS). Radiographic evaluations were performed using calcaneus lateral and axial radiographs, hindfoot alignment radiograph, and CT. Changes in Böhler's angles and calcaneal widths were evaluated both preoperatively and at last followup. Reduction of the posterior facet was graded according to articular step, defect, and angulation of the posterior facet in CT.Results:VAS and AOFAS scores were significantly improved at 1 year after surgery but did not improve further. Böhler's angles and calcaneal widths were significantly improved after surgery. Böhler's angle was significantly smaller at the last followup than immediately after surgery, whereas calcaneal width was maintained. Reduction of the posterior facet was graded excellent in five feet (25%), good in ten (50%), and fair in five (25%) on immediately postoperative CT. Two feet (10%) had transient sural nerve injury which resolved within 3 months. Five feet (20%) had subfibular pain due to a prominent screw heads.Conclusion:Surgical management using a sinus tarsi approach produced good clinical and radiographic results and low wound complications for Sanders type 2 calcaneal fractures. It is important to have stable fixation and to achieve sufficient reduction of calcaneal width for the prevention of loss of reduction and lateral subfibular impingement.

A modified tarsal sinus approach for intra-articular calcaneal fractures

“…Our results were comparable with the results achieved using other minimally invasive techniques. 11,15 Among all the follow-up patients, only one case (3.4%) had skin flap necrosis but was healed after dressing. Another case (3.4%) had symptoms of numbness in the area of sural innervations, which were disappeared after 5 months of physical therapy and drug therapy.…”

Real-Time Automated Segmentation and Classification of Calcaneal Fractures in CT Images

“…We obtained 2210 CT Digital Imaging and Communications in Medicine (DICOM) images from the datasets with assessment and evaluation of the fracture type information [1][2][3][4][5][6][7][8][9][10][11][12][13], radiopedia (https:// radiopaedia.org/), anesthesia key (https://aneskey.com/fractures-and-dislocations-of-the-tarsal-bones/), and CT images from two patients with three anatomical plane orientations. The dataset consists of 815 coronal images, 777 transverse images, and 618 sagittal images.…”

“…The severity of fracture displacement and the extent of soft tissue injury are directly related to the amount of energy absorbed by the limbs in producing injury [3]. Injuries with higher energies produces soft tissue disorders that are more severe and may cause open fractures [4]. Bleeding fractures into the plane of the fascial, which surrounds the heel, produce severe pain above the fracture and may result in a leg compartment syndrome [5].…”

Comminuted calcaneal fracture with avulsion of Achilles insertion treated with the use of intramedullary nailing in the modified original method

“…A large number of authors recommend low-invasive surgical approaches, e.g. sinus tarsi approach [4][5][6][7][8]. Others recommend fracture fixation using cannulated compression screws [9] or Kirschner wires [10], given the cost and extensiveness of the operation.…”