Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Calcaneal fractures can be life changing events with some of the consequences not becoming apparent until years after the initial injury. Some prior studies have suggested that surgical outcomes are no better than nonoperative management. There is still discourse on the best approach when surgical treatment is decided upon. Therefore, we asked: does the sinus tarsi (ST) or extensile lateral (EL) approach provide better patient driven outcomes 5 or more years postoperatively, assessed via PROMIS Scores.
Methods:
A retrospective review on patients treated for calcaneus fracture from a single institution was conducted between January 2012 and December 2019. Demographic, perioperative, radiographic, and complication data was collected, and patient reported outcome measures (PROMIS Scores) were obtained from a prospectively collected registry, queried in December 2024. Groups were stratified by both fracture type and surgical approach. Statistical analysis was done with p< 0.05 considered significant.
Results:
Of 234 possible patients, 70 were at least 5 years out from open reduction and fixation, and complete data on patient outcomes was available for 50 patients (71%); 9 of which were ST (18%) and 41 of which were EL (82%). Preoperative demographics, PROMIS scores, and radiographic measurements of Bohler’s and Gissane’s angles were similar (p>0.05). Postoperative radiographic reduction measures of Bohler’s and Gissane’s angles were similar (p>0.05) and all showed improvement. PROMIS Scores between EL and ST groups were similar (p>0.05) for all domains pre and postoperatively at 5 years except for pain interference (49.0 EL vs. 42.2 ST, p< 0.05). However, both pain interference and intensity showed a clinically significant benefit for the ST group for all time points. Complication rates were equivalent.
Conclusion:
Our 5+ year follow up of patient reported outcomes after open reduction and surgical fixation of calcaneal fractures show the sinus tarsi approach is correlated with both clinically significant lower pain intensity and pain hinderance to daily life at all time points as well as statistically significant lower pain that interferes with daily life at 5 years.
A graph comparing PROMIS pain interference scores between extensile lateral and sinus tarsi approach at preoperative and 1, 2, and 5 years postoperatively (lower is better and a difference of 3+ points is clinically significant).
