Minimally invasive (sinus tarsi) approach for calcaneal fractures

Abstract

BackgroundAccording to the anatomic characteristics of the calcaneus and the sinus tarsi approach, we designed a combined plate. The goal of this study was to retrospectively assess the functional outcomes and complications of treatment with our self-designed plate.MethodsFrom March 2014 to October 2015, 18 patients with closed calcaneal fractures (14 Sanders type II and 4 type III) were treated with our combined locking plate through a minimally invasive sinus tarsi approach. All patients underwent both clinical and radiological evaluations.ResultsThe follow-up duration for all patients ranged from 6 to 13.5 months. The radiographs demonstrated significant corrections of the calcaneal width, length, height, Böhler angle, and Gissane angle from preoperatively to 3 months postoperatively and the last follow-up. However, there were no significant differences in the variables between 3 months postoperatively and the last follow-up. The mean Maryland foot score was 88.1 ± 8.8, in which excellent outcomes were achieved in 11 patients, good in 4, and fair in 3 (excellent and good rate, 83.3% (15 of 18)). No statistical significances in the mean Maryland foot score (88.1 ± 8.8 vs 87.8 ± 10.1, p = 0.9), and the excellent and good rate (85.7 vs 75.0%, p = 1.0) was found between type II and type III fractures. No complications were observed in all fractured feet.ConclusionTreatment with our self-designed combined plate through a sinus tarsi approach may be safe and effective for type II and type III calcaneal fractures.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-016-0497-4) contains supplementary material, which is available to authorized users.

Lateral bone flap approach for displaced intra‐articular calcaneus fractures

“…This finding demonstrated that the calcaneus configuration and strength could be maintained even though the plate was buried in the bone. An average MFS of 87.2 with a good/excellent rate of 90.5% in this study was comparable to the results of the STA, although Sanders type IV fractures were included in this study. Wide exposure of LBFA provided enough room for accurate reduction of fracture.…”

The role of biologic in foot and ankle trauma—a review of the literature

“…Notably, the PR + CSC group had significantly less postoperative woundrelated complications at 7.1% compared to 28.9% in the MISTA group (p = 0.010) [37]. However, the wound complication rate in this study was higher than other studies which had shown little or no wound complications when MISTA was implemented [39,40]. Biggi et al describe the use of balloonassisted augmentation using calcium phosphate, like kyphoplasty for vertebral compression fractures, as a newer, less invasive method for delivering bone grafts in treating calcaneus fractures [38•].…”

An experimental study on the digital precision of internal fixation via the sinus tarsi approach for calcaneal fractures

“…The approach involves entry about 1 cm below the lateral malleolus to the base of the fourth metatarsal and direct exposure of the anterior and posterior subtalar joints and calcaneocuboid joint. 6,14 Compared with the lateral L-type approach, the sinus tarsi approach has the following advantages: (1) it causes less trauma due to its short incision 15 and no damage to the lateral branches of calcaneal vessels, 15 calcaneofibular ligament, and retinaculum musculorm peroneorum inferus; (2) it provides better exposure of the subtalar articular surface and anterior calcaneus 16 ; (3) it causes fewer postoperative incision-related complications, resulting in overall superiority to the lateral L-type approach 5,17,18 ; and (4) it requires a shorter operative time and leads to less bleeding. 19 The disadvantages of this approach include (1) difficulty in reduction due to insufficiency of exposed operative field and failure to effectively reveal the posterior lateral surface of the calcaneus results in difficulty in the restoration of the calcaneus height, width, and heel tubercle, 20 possibly even inducing iatrogenic varus deformity 17 ; (2) stable fixation cannot be achieved for severe complex calcaneal fractures 21 ; and (3) frequently the specialized sinus tarsal bone plates 8 cannot achieve a stable triangular structure and satisfying overall internal fixation in severely complicated fractures.…”

“…19 The disadvantages of this approach include (1) difficulty in reduction due to insufficiency of exposed operative field and failure to effectively reveal the posterior lateral surface of the calcaneus results in difficulty in the restoration of the calcaneus height, width, and heel tubercle, 20 possibly even inducing iatrogenic varus deformity 17 ; (2) stable fixation cannot be achieved for severe complex calcaneal fractures 21 ; and (3) frequently the specialized sinus tarsal bone plates 8 cannot achieve a stable triangular structure and satisfying overall internal fixation in severely complicated fractures. The sinus tarsi approach is very suitable for Sanders II and III calcaneal fractures 6 but not for severe Sanders type III fractures. 16,22 Thus, it does not completely replace the traditional lateral L-shaped approach.…”