Sinus Tarsi Approach with Trans-articular Fixation for Displaced Intra-articular Fractures of the Calcaneus

Abstract

The charts and radiographs of 99 patients with 106 intraarticular fractures of the calcaneus were retrospectively reviewed. There were 75 men and 24 women. The average age was forty-two (range, 17 to 81). Fifty-seven of the fractures were left and 49 were right. The mechanism of injury was a fall from a height in 69 patients and motor vehicle accident in 30 patients. According to Sanders classification, seventy-one cases (67%) had type II fractures, 25 cases (23.6%) had type III, and ten cases (9.4%) had type IV. All the patients had operative management through a limited sinus tarsi approach with minimal fixation of the fracture with one or several pins. One of the pins was usually applied from the talus to the calcaneus through the fracture after reduction of the posterior facet. Nine cases (8.5%) developed postoperative infection, four cases (3.8%) had superficial wound infection, four cases (3.8%) had pin tract infection and one case (0.9%) had osteomylitis. Our follow-up at an average of 29 months (range, 12 to 84 months) showed that the American Orthopedic Foot and Ankle Society, Ankle-Hindfoot Score for the all group was 77.6 (range, 31-91). Forty-one fractures (38.8%) were graded excellent, 39 fractures (36.7%) good, 14 fractures (13.2%) fair, and 12 fractures (11.3%) were failures. Although radiological degenerative changes in the subtalar joint were seen in 41 cases (38.7%), only six cases (5.6%) required subsequent subtalar fusion. The authors conclude that the operative method used in the current study which followed the principle of minimal soft tissue damage and minimal internal fixation may be a good option for management of calcaneus fractures.

Radiographic evaluation of calcaneal fractures: to measure or not to measure

“…Frequently, there is no correlation between the angle and functional results of treatment [7,11,37,38]. Correlations between the crucial angle, as described by Gissane, and the final outcome were never found [11,20,38].…”

“…Several studies found correlations with the outcome and measurements of Böhler's angle, usually with extremes of Böhler's angle or when division of Böhler's angle into three groups was applied ("less than zero degrees", "zero to 15°" and "16°or higher") [33][34][35][36]. Frequently, there is no correlation between the angle and functional results of treatment [7,11,37,38]. Correlations between the crucial angle, as described by Gissane, and the final outcome were never found [11,20,38].…”

A Comparison of Extensile Lateral Approach and Sinus Tarsi Approach for the Sanders Type II Calcaneal Fracture

“…, 둘째는 관절경을 이용하는 방법 6,14) , 셋째는 외고정 장치를 이용하는 방법이다 10,12,15) . 짧은 절개를 이용하는 방법은 족근동에서 거골하 관절을 따라서 절개를 하거나 4,7,8) 아킬레스건의 외측연을 따라서 종절개를 하는 방법 13) 으로 크게 구분할 수 있다. 짧은 절 개를 하면 후방 관절면의 외측 관절면을 포함하는 골절편 의 전위를 육안적으로 보고 정복할 수 있다는 것이 장점이 지만 전체적인 윤곽이나 관절면 이외의 부분은 경피적으로 정복하고 고정해야 한다.…”

Fraturas intra-articulares do calcâneo: análise clínica e biomecânica

“…Fernandes (35) relatou sua experiência com 38 casos, todos tratados cirurgicamente com a via de acesso pelo seio do tarso, tendo três casos (7,89%) de sofrimento tecidual superficial. Ebraheim et al (36) avaliaram o resultado obtido pela via curta em 99 pacientes (106 pés), tendo apenas quatro casos (3,8%) de infecção superficial e um caso (0,9%) de infecção profunda. Avaliaram a vantagem da via em abordar diretamente a faceta posterior e o aspecto anterior e lateral, tendo como limitação a redução indireta da tuberosidade posterior e do sustentáculo do tálus.…”