Radiographic and clinical results of modified 2-incision sinus tarsi approach for treatment of calcaneus fracture

• Published in: Injury 2021-07, Vol.52 (7), p.1971-1977
• Main Authors: Wang, Chien-Shun, Tzeng, Yun-Hsuan, Yang, Tzu-Cheng, Lin, Chun-Cheng, Chang, Ming-Chau, Chiang, Chao-Ching
• Format: Article
• Language: English
• Subjects: 2-Incision; Calcaneal fracture; Minimally invasive surgery; Sinus tarsi approach
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2021.05.010

1The modified 2-incision sinus tarsi approach is effective, reliable, and safe.2This modification allows easy placement of a standard calcaneal plate.3Complete separation of the lateral wall fragment from the soft tissue flap is essential. Sinus tarsi approach (STA) is the most commonly used minimally invasive surgery (MIS) in the treatment of displaced intra-articular calcaneal fracture (DIACF). However, there are some limitations related to its limited access. The goal of the present study is to describe a modified 2-incision STA and to evaluate the radiographic and clinical outcomes in the treatment of DIACF. Patients had a Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification 82-C, Sanders type II, III calcaneal fracture, and underwent modified 2-incision STA and internal fixation were included in this retrospective study. Serial radiographic measurements and clinical assessment were taken to evaluate the effectiveness of this technique. Thirty-four feet of 33 patients treated between 2014 and 2019 were included with an average follow-up of 28.5 (range, 12-65) months. Mean preoperative Böhler's angle was 1.5 ± 10.0 (range, -26.0-16.9) degrees and mean final Böhler's angle was 29.8 ± 4.9 (range, 19.3-39.3) degrees with significant difference (P < .001). The average American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) pain score at last follow-up were 86.2 ± 5.0 (range, 76-97) and 1.6 ± 1.1 (range, 0-4), respectively. Major complications included 2 (5.9%) wound infections and 1 (2.9%) incomplete separation of the lateral wall prior to plate insertion. This modified 2-incision STA is a safe and effective procedure. It allows access to the posterior facet and posterior calcaneal tuberosity, appropriate restoration of blowout lateral wall, and easy placement of a standard calcaneal plate.