Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach

Je-Hyoung Yeo, Hyun-Jong Cho, Keun-Bae Lee, Je-Hyoung Yeo, Hyun-Jong Cho, Keun-Bae Lee

Abstract

Background: Two common surgical approaches included the sinus tarsi and extensile lateral are used for displaced intra-articular calcaneal fractures. However, few studies have compared outcome of treated by the two approaches. The purpose of this study was to compare the outcome between these two approaches for Sanders type-II and type-III fractures.

Methods: This retrospective cohort study was performed from 2004 to 2011. Open reduction and internal fixation using the sinus tarsi and extensile lateral approach was studied in 100 cases (40 sinus tarsi and 60 extensile lateral) with displaced intra-articular calcaneal fractures. All patients were evaluated both clinically and radiologically.

Results: Median Böhler and Gissane angle were improved to 26.5 degree (4.6 to 45), 115.5 degree (101.2 to 127.4) in the sinus tarsi group and 25.3 degree (3.7 to 44.6), 119.0 degree (73.5 to 145.6) in extensile lateral group at the final follow-up, respectively. Median calcaneal height, length, and width in the sinus tarsi and extensile lateral groups showed improvement to 45.1 mm (23.2 to 54.1), 75.9 mm (64.9 to 90.3), 37.6 mm (29.2 to 53.9) and 46.5 mm (32.7 to 59.5), 76.1 mm (67.3 to 97.9), 39.3 mm (29.2 to 47.8) at the final follow-up, respectively. Median AOFAS score was checked to 90 points (76 to 94) in the sinus tarsi group and 86 points (76 to 94) in the extensile lateral group at the final follow-up. No significant differences in clinical and radiologic outcomes were observed between the two groups. However, wound complication rate (13.3%) in the extensile lateral group was significantly higher compared to the sinus tarsi group (p-value = 0.022).

Conclusions: The final clinical and radiographic outcomes between the two approaches for Sanders type-II and type-III intra-articular calcaneal fractures were comparable and equally successful. The selective sinus tarsi approach appears to be an effective and reliable method for the treatment of Sanders type-II and type-III fractures.

Figures

Figure 1
Figure 1
Photograph showing skin incision line and surgical approach. (A) Sinus tarsi approach (STA) (B) Extensile lateral approach (ELA).
Figure 2
Figure 2
Radiologic evaluations of a 55 year old male patient with Sanders type-II intra-articular calcaneal fracture treated with open reduction and internal fixation using the sinus tarsi approach. (A) Preoperative plain radiographs and CT scans (B) Postoperative plain radiographs.
Figure 3
Figure 3
Radiologic evaluations of 52 year old male patient with Sanders type-II intra-articular calcaneal fracture treated with open reduction and internal fixation using the extensile lateral approach. (A) Preoperative plain radiographs and CT scans (B) Postoperative plain radiographs.

References

    1. Letournel E. Open treatment of acute calcaneal fracture. Clin Orthop Relat Res. 1993;290:60–7.
    1. Femino JE, Vaseenon T, Levin DA, Yian EH. Modification of the sinus tarsi approach for open reduction and plate fixation of intra-articular calcaneus fractures: The limits of proximal extension based upon the vascular anatomy of the lateral calcaneal artery. Iowa Orthop J. 2010;30:161–7.
    1. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Ortho Relat Res. 1993;290:87–95.
    1. Jiang N, Lin QR, Diao XC, Wu L, Yu B. Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. Int Orthop. 2012;36:1615–22. doi: 10.1007/s00264-012-1563-0.
    1. de Boer AS, van Lieshout EM, den Hartoq D, Weerts B, Verhofstad MH, Schepers T. Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment. J Foot Ankle Surg. 2014. Epub ahead of print.
    1. Agren PH, Wretenberg P, Sayed-Noor AS. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2013;95:1351–7. doi: 10.2106/JBJS.L.00759.
    1. Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomized controlled trial. BMJ. 2014;349:g4483. doi: 10.1136/bmj.g4483.
    1. Tornetta P., 3rd The Essex-Lopresti reduction for calcaneal fractures revisited. J Orthop Trauma. 1998;12:469–73. doi: 10.1097/00005131-199809000-00007.
    1. Schepers T. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systemic review. Int Orthop. 2011;35:697–703. doi: 10.1007/s00264-011-1223-9.
    1. Gould N. Lateral approach to the oscalcis. Foot Ankle. 1984;4:218–20. doi: 10.1177/107110078400400416.
    1. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2000;82:225–50.
    1. Tennent TD, Calder PR, Salisbury RD, Allen PW, Eastwood DM. The operative management of displaced intra-articular fractures of the calcaneum: A two-centre study using a defined protocol. Injury. 2001;32:491–6. doi: 10.1016/S0020-1383(01)00024-9.
    1. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures. J Bone Joint Surg Am. 2002;84:1733–44.
    1. Al-Mudhaffar M. Wound complications following operative fixation of calcaneal fracture. Injury. 2009;31:461–4. doi: 10.1016/S0020-1383(00)00026-7.
    1. Benirschke SK, Kramer PA. Wound healing complications in closed and open calcaneal fractures. J Orthop Trauma. 2004;18:1–6. doi: 10.1097/00005131-200401000-00001.
    1. Harvey EJ, Grujic L, Early JS, Benirschke SK, Sangeorzan BJ. Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int. 2001;11:868–73.
    1. Carr JB. Surgical treatment of intra-articular calcaneal fractures: a review of small incision approaches. J Orthop Trauma. 2005;19:109–17. doi: 10.1097/00005131-200502000-00007.
    1. Holmes GB. Treatment of displaced calcaneal fractures using a small sinus tarsi approach. Tech Foot Ankle Surg. 2005;4:35–9. doi: 10.1097/01.btf.0000156336.58175.e1.
    1. Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int. 2013;34:773–80. doi: 10.1177/1071100713477607.
    1. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349–53. doi: 10.1177/107110079401500701.
    1. Sangeorzan BJ, Benirschke SK, Carr JB. Surgical management of fractures of the oscalcis. Instr Course Lect Am Acad Orthop Surg. 1995;44:359–70.
    1. Lee KB, Chung JY, Song EK, Seon JK, Bai LB. Arthroscopic release for painful subtalar stiffness after intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2008;90:1457–61. doi: 10.1302/0301-620X.90B11.20744.
    1. Benirschke SK, Sangeorzan BL. Extensive intra-articular fractures of the foot: Surgical management of calcaneal fractures. Clin Orthop Relat Res. 1993;29:128–34.
    1. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: An analysis of 190 fractures. J Orthop Trauma. 1999;13:369–72. doi: 10.1097/00005131-199906000-00008.
    1. Weber M, Lehmann O, Sagesser D, Krause F. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2008;90:1608–16. doi: 10.1302/0301-620X.90B12.20638.
    1. Rammelt S, Heineck J, Barthel S, Zwipp H. Percutaneous fixation of intraarticular calcaneus fractures. Tech Foot Ankle Surg. 2009;8:70–6. doi: 10.1097/BTF.0b013e3181a77f71.
    1. Smerek JP, Kadakia A, Belkoff SM, Knight TA, Myerson MS, Jeng CL. Percutaneous screw configuration versus perimeter plating of calcaneus fractures: A cadaver study. Foot Ankle Int. 2008;29:931–5. doi: 10.3113/FAI.2008.0931.
    1. Ebraheim NA, Elgafy H, Sabry FF, Freih M, Abou-Chakra IS. Sinus tarsi approach with trans-articular fixation for displaced intra-articular fractures of the calcaneus. Foot Ankle Int. 2000;21:105–13.
    1. Park N, Song K, Shin S. Displaced intra-articular calcaneal fracture treated surgically with limited posterior incision. Foot Ankle Int. 2000;21:195–205.
    1. Talarico LM, Vito GR, Zyryanov SY. Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weightbearing. J Foot Ankle Surg. 2004;43:43–50. doi: 10.1053/j.jfas.2003.11.010.
    1. Hospodar P, Guzman C, Johnson P, Uhl R. Treatment of displaced calcaneus fractures using a minimally invasive sinus tarsi approach. Orthopedics. 2008;31:1112–7. doi: 10.3928/01477447-20081101-08.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner