Abstract
Category:
Trauma; Other
Introduction/Purpose:
Calcaneal fracture surgery represents one of the most challenging procedures for orthopedic surgeons. Recently, the use of the sinus tarsi approach for treating calcaneal fractures has been gaining popularity. Prior to this investigation, research was lacking on the learning curve of the sinus tarsi approach for calcaneal fracture surgeries among orthopedic surgeons newly initiating independent surgical practice. This study aims to delineate the learning curve of junior professors, who have recently completed their fellowship and are beginning to lead calcaneal fracture surgeries, using the sinus tarsi approach and its correlation with clinical outcomes, underscoring the critical importance of specialized surgical expertise.
Methods:
From October 2022 to January 2024, a total of 50 cases of calcaneal fractures, specifically Sanders types 3 and 4, treated surgically using the sinus tarsi approach at a single level 1 trauma center were analyzed to study the learning curve. The cutoff values for each parameter according to the number of surgical cases were analyzed using the cumulative sum test. The degree of correction for the Bohler angle, hindfoot varus angle, and posterior facet step-off was analyzed using preoperative and postoperative X-rays and Computed Tomography. Additionally, the number of C-arm fluoroscopy shots during surgery and the duration of the operation were examined. Postoperative complications, including infections, and the need for revision surgery were also analyzed.
Results:
The study included 23 cases of Sanders type 3 fractures and 27 cases of type 4 fractures. Significant improvements were observed with the Bohler angle increasing from an average of 12.2 degrees preoperatively to 26.3 degrees postoperatively, the hindfoot varus angle reducing from 15.2 degrees to 5.3 degrees, and the posterior facet step-off decreasing from 14.1mm to 0.56mm. The CUSUM for satisfactory correction of the Bohler angle and hindfoot varus was 21 cases each, and the posterior facet step off was 26 cases. The average duration of surgery was 104 minutes and the CUSUM was 24 cases. The average number of C-arm fluoroscopy shots during surgery was 141 and the CUSUM was 20 cases.
Conclusion:
As indicated by multidimensional statistical analyses, novice foot and ankle surgeon can achieve a plateau of proficiency after the initial learning period with 20 to 26 cases.