Extended Sinus Tarsi Approach for Treatment of Displaced Intraarticular Calcaneal Fractures Compared to Extended Lateral Approach

Abstract

Background:

We compared the radiographic results and clinical outcomes of patients operated on via the extended sinus tarsi approach (ESTA) and the extended lateral approach (ELA) for treatment of displaced intraarticular calcaneal fractures.

Methods:

We retrospectively studied the utility of the ELA (46 patients, 52 feet) and the ESTA (56 patients, 64 feet) in patients operated on between January 2009 and March 2015. We evaluated pre- and postoperative x-rays and computed tomography (CT) data. Pain, patient-reported functional outcomes, satisfaction, and postoperative complications were investigated at the 3-year follow-up.

Results:

Neither the postoperative nor 3-year follow-up Böhler angles, nor the calcaneal width, differed significantly between the 2 groups (both P > .05). However, the maximum step-off of the posterior facet on the 3-month CT follow-up of the ESTA group was significantly less than that of the ELA group (P < .05). We found no significant between-group differences in terms of postoperative translation (P = .232) or angulation (P = .132) of the sustentacular fragment on the 3-month CT follow-up. At the 3-year follow-up, we found no significant between-group difference in the mean visual analog scale pain score at rest (P = .641) or during weightbearing (P = .525). We found no significant between-group difference in the Foot Function Index (FFI) (P = .712) or self-reported satisfaction (P = .823). The ELA group experienced significantly more wound complications (P = .041) and nonunions (P = .041) than the ESTA group. Four instances of superficial peroneal nerve injury were reported in the ESTA group (P = .127).

Conclusion:

Compared with the ELA, the ESTA afforded comparable, favorable radiological results and clinical outcomes, associated with fewer wound complications and nonunions. We suggest that the ESTA is an effective operative option when treating displaced, intraarticular calcaneal fractures.

Level of Evidence:

Level III, comparative study.

Keywords

calcaneus fracture sinus tarsi extended sustentaculum tali posterior facet

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