A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures

Nosewicz, Tomasz L.; Dingemans, Siem A.; Backes, Manouk; Luitse, Jan S. K.; Goslings, J. Carel; Schepers, Tim

doi:10.1016/j.fas.2018.08.006

Cited by 45 publications

(41 citation statements)

References 53 publications

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“…At our center, a wound complication rate of 31% has been previously described with the use of the ELA [10] . Our results seem to be in line with a recent systematic review and meta-analysis, in which an infection rate of 4.9% is described in the STA [1] . Our slightly higher infection rate may be attributed to the fact that as the STA gains in popularity, more complex fractures and patients with increased risk for wound complications are treated via this approach.…”

Section: Discussionsupporting

confidence: 93%

Risk factors for surgical site infections with the Sinus Tarsi Approach in displaced intra-articular calcaneal fractures; a prospective cohort study with a minimum of one year follow-up

Spierings

Sanders

Nosewicz

et al. 2020

Injury

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Background: In the last decade, the sinus tarsi approach (STA) has gained interest over the extensile lateral approach (ELA) in the operative treatment of displaced intra-articular calcaneal fractures (DIACF's), mainly because of the lower rate of surgical site infections (SSIs). However, most studies are small and retrospective. The aim of this study was to evaluate the rate of SSIs of the STA in a large, prospective series of patients and to identify predictors for SSIs. Methods: In this prospective cohort study, all consecutive patients who were operatively treated for a DIACF in our Level 1 trauma center between August 2012 and January 2019 were included and followed for at least one year. All operative procedures were performed by two specialized foot and ankle trauma surgeons using the STA. Using multinomial logistic regression, risk factors for SSIs were identified. Results: A total of 237 calcaneal fractures in 214 patients were included, of which 179 underwent open reduction and internal fixation and 58 a primary arthrodesis. Most patients were male (73.6%) and the mean age was 45.9 years. There were 16 patients that developed a SSI (6.8%), of which 9 (3.8%) were deep and 7 (3%) were superficial infections. The multivariate analysis pointed out that surgery within one week after injury increased the chance of a SSI, as well as an ASA of 2 or higher and more than 150 cc of blood loss during the procedure. Conclusion: This study confirms the low risk of SSI in DIACFs treated via STA. Significant predictors for SSIs were surgery within one week after injury, ASA of 2 or higher and blood loss > 150cc.

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Section: Discussionsupporting

confidence: 93%

Risk factors for surgical site infections with the Sinus Tarsi Approach in displaced intra-articular calcaneal fractures; a prospective cohort study with a minimum of one year follow-up

Spierings

Sanders

Nosewicz

et al. 2020

Injury

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“…A total of 100 articles were found and were finalized to include five articles in the study. 15,16,25 –27 These five meta-analyses were published in 2017 and 2018. The characteristics of the included literature are presented in Table 1. The characteristics of the original studies in the literature are presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses

Xiong

Kang

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Accumulated literature has reported the comparative efficacy of the sinus tarsi approach (STA) and the extensile lateral approach (ELA) for the treatment of calcaneal fractures (CFs). However, the best alternative treatment for CF is still inconsistent. Herein, the present systematic review of overlapping meta-analyses aims to achieve an evident conclusion by performing a comprehensive reanalysis of previous meta-analyses regarding the comparison of the STA and the ELA. Methods: We searched several databases, including Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov , OVID, and CNKI for the meta-analyses comparing the STA and the ELA for the treatment of CF. All related meta-analyses of randomized controlled trials and cohort studies were included. Two researchers independently assessed the quality of the articles and extracted the data. The Jadad decision algorithm was used to evaluate the evidence of the articles. Results: Ultimately, five meta-analyses were included in the present study. The Assessment of Multiple Systematic Reviews scores of these articles ranged from 5 to 9 with a median of 7. The analysis of best quality, Bai 2018, was selected based on the Jadad algorithm. In this article, the significant differences were found in wound complications and operating time, recovery of Böhler’s angle, the American Orthopaedic Foot and Ankle Society scores, and the visual analog scale. Conclusion: The clinical relevance of the present study is that both the STA and the ELA are effective in alleviating pain and improving functionality in the treatment of CF. However, due to a shorter operation duration and lower complication rates, the STA was indicated to be a superior alternative for CF treatment.

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“…A minimally invasive incision approach is considered the future direction in the development of calcaneal fracture treatment 8 .The traditional L-shaped incision cuts off the blood supply to the centre and front of the lateral wall of the calcaneus and destroys the vascular network of the plantar ap. Therefore, the complication rate of wound healing is 11%~24.9%, which seriously affects the treatment of calcaneal fractures 6,9 . Meanwhile, because of its minimally invasive nature and fewer wound healing complications, the sinus tarsi approach has been used more and more frequently in the treatment of calcaneal fractures.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach

Zhao

Zhang

et al. 2021

Preprint

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The purpose of this study was to assess the clinical efficacy and complications of a modified sinus tarsi approach (MSTA) and the extensile lateral approach (ELA) for the treatment of displaced intra-articular calcaneal fractures. In a retrospective design, 108 patients (117 feet) with Sanders II~IV calcaneal fractures were enrolled in this study, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The postoperative functional and radiological results showed that the average AOFAS scores and VAS scores of the MSTA group were higher than that of the ELA group (p<0.05). After surgery, the Bohler Angle, Gissane Angle, and the length, width, and height of the calcaneus were significantly improved in the MSTA group and the ELA group, but there were no statistically significant differences between the two groups. The incidences of wound healing complications and postoperative sural nerve injury were lower in the MSTA group than in the ELA group (p<0.000). In conclusion, the MSTA was able to achieve similar effects of anatomical reconstruction and function recovery as the ELA, while also effectively reducing the incidences of wound healing complications and postoperative sural nerve injury and shortening the length of hospital stay.

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A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures

Cited by 45 publications

References 53 publications

Risk factors for surgical site infections with the Sinus Tarsi Approach in displaced intra-articular calcaneal fractures; a prospective cohort study with a minimum of one year follow-up

Risk factors for surgical site infections with the Sinus Tarsi Approach in displaced intra-articular calcaneal fractures; a prospective cohort study with a minimum of one year follow-up

Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses

Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach

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