Management of displaced intra-articular calcaneal fractures using the limited open sinus tarsi approach and fixation by screws only technique

Abstract

Purpose Evaluation of management of the displaced intraarticular calcaneal fractures (DIACF) Sanders types II and III by using minimally invasive sinus tarsi approach and fixation by screws only technique. Methods Open reduction using the limited lateral approach and internal fixation using screws only was studied in 33 patients with unilateral isolated simple DIACF with a mean age of 35 years (15 type II patients and 18 type III patients). All patients were evaluated both clinically and radiologically. Results With a mean follow-up period of 28.8 months (range 12-53 months), no cases of failure of reduction or displacement of hardware were detected. The mean AOFAS was 91.73 points while the mean MFS was 95.09 points. Twenty-eight patients were able to resume their pre-injury level of work while the remaining five refrained to sedentary jobs. The mean pre-operative Bohlers' angle was 2.8°(range from -38º to 24º) while postoperatively it was 19.4°(range 5º to 49º). There was no statistically significant difference when comparing the results (AOFAS p-value 1.00, MFS p-value 0.81) between Sanders' type II and III fractures.One patient had postoperative superficial wound infection. Seven patients complained of prominent screw heads. Complex regional pain syndrome occurred in seven patients and was treated successfully at six months duration.Conclusion The limited open sinus tarsi approach can be used successfully to treat displaced Sanders type II and III fractures. It allows for adequate visualization and reduction. Fixation by screws only is also sufficient. It also clearly avoids the major wound complication problems.

Towards uniformity in communication and a tailor-made treatment for displaced intra-articular calcaneal fractures

“…However, these results come at a cost, namely wound complications. Recently, the pendulum has begun to swing back to lessinvasive procedures [15], of which two strategies stand out: the percutaneous technique and the sinus tarsi approach.There is a steep increase in interest and publications on the sinus tarsi approach, and studies show that the sinus tarsi approach is a viable addition to the armament for treating displaced intra-articular fractures [1]. These findings are supported by the growing body of evidence on the sinus tarsi approach (PubMed and Google Scholar search).…”

“…There is a steep increase in interest and publications on the sinus tarsi approach, and studies show that the sinus tarsi approach is a viable addition to the armament for treating displaced intra-articular fractures [1]. These findings are supported by the growing body of evidence on the sinus tarsi approach (PubMed and Google Scholar search).…”

“…These findings are supported by the growing body of evidence on the sinus tarsi approach (PubMed and Google Scholar search). Approximately 17 published series report on the sinus tarsi approach or on a modified sinus tarsi approach [1][2][3][4][5][6][7][8][9][10][11][12][13][14][16][17][18]. These case series involve 491 patients (average 29 per study; range 13-99), with 528 calcaneal fractures (31 average per study; range 13-106).…”

Reduction and internal fixation of displaced intra-articular calcaneal fractures with a locking nail: a prospective study of sixty nine cases

“…height, width and length, should be restored to provide the best possible walking capacities. So, alternative procedures have been proposed, including two-stage procedures [5,6], minimally invasive techniques [7][8][9][10], balloon reduction and cement fixation [11,12] and even a tailormade treatment strategy [13]. Indeed, most minimally invasive techniques achieve reduced primary stability and reduction accuracy is difficult to verify even with arthroscopy or 3D fluoroscopy.…”

Open reduction and internal fixation by extensile lateral approach in displaced intra-articular fracture Calcaneum: A study of 44 cases

“…ORIF is associated with potential complications of flap necrosis, neuro-vascular injury, post-traumatic arthritis and potential non-union leading to considerable morbidity in some patients [15][16][17] . In order to circumvent the potential complications of ORIF newer minimally invasive approaches have come up with different implants but all are under close scrutiny and a matter of ongoing debate and research with each having marginal advantages and disadvantages over one another [18][19][20] . The extensile lateral approach has been considered the gold standard approach for treatment of displaced intra-articular fractures.…”