Clinical Outcomes of Minimally Invasive Surgery in Sanders Type IV Intra-Articular Calcaneal Fractures

PURPOSE: This study evaluated the radiologic and clinical results in patients who underwent minimal invasive surgery using sinus tarsi approach in Sanders type IV calcaneal fracture. MATERIALS AND METHODS: This retrospective study evaluated 13 cases of Sanders type IV calcaneus fractures that were treated by minimal invasive surgery using the sinus tarsi approach from July 2012 to April 2017. Further, these cases could be followed up for more than 12 months. Bone union, radiologic parameters such as Böhler's angle, Gissane's angle, calcaneal height, length, and width, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the postoperative complications were evaluated. RESULTS: Bony union was achieved in all the cases at the final follow up, and the mean union time was 5.5 months. One patient underwent reoperation for a surgical site infection, six patients had post traumatic arthritis, and two of them underwent subtalar joint fusion. The mean AOFAS ankle-hindfoot score was 81.2. At the final follow-up, the mean values of Böhler's angle and Gissane's angle were 20° and 119.8°, respectively, and the mean values of the calcaneus height, length, and width were 46.8 mm, 81.8 mm, and 45.6 mm, respectively. CONCLUSION: Minimal invasive surgery using the sinus tarsi approach for Sanders type IV calcaneal fracture resulted in satisfactory anatomic reduction and stable fixation, and satisfactory clinical and radiologic results were obtained in most of the patients. Minimal invasive surgery is thought to reduce the soft tissue-related complications as compared to surgery using the extensile lateral approach.

Effect of sinus tarsi approach in patients with calcaneus fracture combined with high risk factors of incision complications / 中国医师进修杂志

Objective@#To study the effect of sinus tarsi approach in patients with calcaneus fracture combined with high risk factors of incision complications.@*Methods@#The clinical data of 18 patients with calcaneus fracture combined with high risk factors of incision complications in Jinzhou Center Hospital from July 2015 to July 2017 were retrospectively analyzed. In all patients, combined diabetes mellitus was in 8 cases, long-term smoking history was in 13 cases, combined diabetes mellitus and smoking was in 3 cases. Active and passive smoking were prohibited in hospital, and fasting and postprandial blood glucose were monitored and controlled. In order to reduce swelling, plaster fixation, limb elevation and cold compression were performed. After the blood glucose was stable and local swelling was reduced, surgery was performed via the sinus tarsi approach. After 1 to 2 weeks of postoperative gypsum fixation, the non-weight-bearing function exercise was allowed. After early activities and late loading, the weight-bearing function exercise began at least 12 weeks after surgery.@*Results@#All patients were followed up for 12 to 20 months (mean 14.3 months). No skin necrosis and infection occurred. All fractures healed, and fracture healing time was 11 to 16 weeks, with mean time of 13.5 weeks. The American Orthopaedic Foot and Ankle Society Ankle Hindfoot score was used to evaluate the curative effect. Six cases were excellent, 10 cases were good, and 2 cases were passable.@*Conclusions@#Treatment of calcaneal fracture via tarsal sinus approach has little interference with soft tissue. It is especially suitable for the patients with high risk factors of incision complications, which can effectively avoid the occurrence of incision complications. At the same time, the postoperative functional recovery is satisfactory. It is a good approach in patients with calcaneal fracture combined with high risk factors of incision complications.

Effect of sinus tarsi approach in patients with calcaneus fracture combined with high risk factors of incision complications / 中国医师进修杂志

Objective To study the effect of sinus tarsi approach in patients with calcaneus fracture combined with high risk factors of incision complications. Methods The clinical data of 18 patients with calcaneus fracture combined with high risk factors of incision complications in Jinzhou Center Hospital from July 2015 to July 2017 were retrospectively analyzed. In all patients, combined diabetes mellitus was in 8 cases, long-term smoking history was in 13 cases, combined diabetes mellitus and smoking was in 3 cases. Active and passive smoking were prohibited in hospital, and fasting and postprandial blood glucose were monitored and controlled. In order to reduce swelling , plaster fixation, limb elevation and cold compression were performed. After the blood glucose was stable and local swelling was reduced, surgery was performed via the sinus tarsi approach. After 1 to 2 weeks of postoperative gypsum fixation, the non-weight-bearing function exercise was allowed. After early activities and late loading, the weight-bearing function exercise began at least 12 weeks after surgery. Results All patients were followed up for 12 to 20 months (mean 14.3 months). No skin necrosis and infection occurred. All fractures healed, and fracture healing time was 11 to 16 weeks, with mean time of 13.5 weeks. The American Orthopaedic Foot and Ankle Society Ankle Hindfoot score was used to evaluate the curative effect. Six cases were excellent, 10 cases were good, and 2 cases were passable. Conclusions Treatment of calcaneal fracture via tarsal sinus approach has little interference with soft tissue. It is especially suitable for the patients with high risk factors of incision complications, which can effectively avoid the occurrence of incision complications. At the same time, the postoperative functional recovery is satisfactory. It is a good approach in patients with calcaneal fracture combined with high risk factors of incision complications.

Comparison of two surgical approaches in treatment of calcaneal fracture / 中国医师进修杂志

Objective To compare sinus tarsi approach(STA) and extensile L shape approach (ELA) in the surgical treatment of calcaneal fractures. Methods A total of 51 cases of calcaneal fractures treated from May 2014 to December 2016 were enrolled. Twenty of them were performed ORIF via the sinus tarsi approach, while the other 31 cases were performed ORIF via lateral extensile L shape approach. X-ray films were taken postoperatively to record the changes of B?hler angle and Gissane angle. The AOFAS, VAS and SF-36 scores were adopted to assess the therapeutic effect. Results The average follow-up period of STA group was 15.5 months. And patients in ELA group were followed up for an average period of 18.4 months. All the fractures in the series had a boney union at or before the final follow-up. The final correction of B?hler angle (34.60 ± 2.91)° , and Gissane angle (114.45 ± 2.91)° was significantly increased in the STA group; and the final correction of B?hler angle (33.55 ± 2.73)° , and Gissane angle (112.81 ± 4.15)° was also significantly increased in the ELA group; while there was no significant difference between the two groups. The final AOFAS scores , VAS scores and SF-36 scores of the STA were (83.56 ± 7.13), (1.78 ± 0.89), (88.95 ± 4.31) scores, while those in ELA group were (81.91 ± 9.89), (2.01 ± 1.33) and (86.65 ± 4.95) scores. There was no significant difference between the two groups (P>0.05). No wound problem happened in STA group, but there were 2 cases who had wound complications in ELA group. Conclusions No significant difference is found between the two groups in the short-term efficacy of the treatment for calaneal fracture. However, STA has the advantages of lower soft tissue complication rate.

Sinus Tarsi Approach Internal Fixation in the Treatment of Sanders Type Ⅱ and Ⅲ Calcaneum Fracture / 中国微创外科杂志

Objective To explore the efficacy of internal fixation in the treatment of intra-articular calcaneum fractures via the sinus tarsi approach . Methods A retrospective study was made on 55 feet with intra-articular calcaneum fractures in 51 patients treated with open reduction and intemal fixation via sinus tarsi approach from January 2010 to June 2015.According to the Sanders classification, there were 15 feet of type Ⅱfractures and 40 feet of type Ⅲfractures. Results All the patients were followed up for a mean period of 15.7 months (range, 6-33 months).The fractures were completely healed .According to the Maryland Foot Scores , the operative effect was excellent in 43 feet, good in 7 feet, fair in 4 feet, and poor in 1 foot.The excellent and good rate was 90.9%(50/55).The postoperative width of the calcaneum , B?hler angle, and Gissane angle were significantly improved than before operation (P=0.000). Conclusion Open reduction and internal fixation via sinus tarsi approach is a simple and effective method for minimally invasive treatment of Sanders type Ⅱand Ⅲintra-articular calcaneum fractures .

Sinus tarsi approach with minimal-invasive percutaneous screw fixation of calcaneal fractures:an analysis of clinical effects / 临床外科杂志

Objective To analyze the clinical effects of sinus tarsi approach with minimal-inva-sive percutaneous screw fixation of calcaneal fractures. Methods From February 2014 to July 2015,28 ca-ses of calcaneal fracture patients(Sanders Ⅰ ~ Ⅲ)were treated with minimal-invasive percutaneous screw fixation via sinus tarsi approach in our department. There were 18 males and 10 females with age ranging from 16 to 68 years(mean,32 years). According to the classification of Sanders,six cases were classified as Type I,twelve as Type Ⅱ,and ten as Type Ⅲ. The Bohler angle and Gissane angle were compared be-fore and after operation. Clinical results were evaluated with the Maryland foot scoring system. Results All the patients were followed up for 14 to 20 months(mean,15. 5 months). Anatomic or almost anatomic reduction was achieved in all patients according to the results of postoperative images. All fractures healed,and the healing time ranged from 4 to 7 months(average,5. 3 months). There was no wound infec-tion,necrosis or bone nonunion. According to the Maryland foot scoring system,16 cases were defined as excellent,10 cases as good,and 2 cases as poor. The good and excellent rate was 92. 8% . Conclusion For calcaneal fractures,sinus tarsi approach with minimal-invasive percutaneous screw fixation has the ad-vantages of small trauma,safe operation,limited complication,and stable fixation,which is a satisfactory clinical treatment.

Treatment of Displaced Intra-articular Calcaneal Fractures by Minimally Invasive Retractor Reduction and Fixation Through Sinus Tarsi Approach Together with External Application of Chinese Medicine / 广州中医药大学学报

Objective To evaluate the therapeutic effect of minimally invasive retractor reduction and fixation through sinus tarsi approach together with external application of Chinese medicine for displaced intra-articular calcaneal fractures. Methods From October of 2009 to June of 2013, 52 patients with displaced intra-articular calcaneal fractures (Sanders type Ⅱ, Ⅲ) were enrolled into the study. The patients received minimally invasive retractor reduction through sinus tarsi approach and fixation with small plate and cannulated screws, and after the operation were given external washing with Chinese herbal formula Shenxing Fang ( mainly composed of Herba Lycopodii, Herba Speranskiae Tuberculatae, Rhizoma Sparganii, Rhizoma Curcumae, Herba Asari, Radix Aconiti Preparata, Radix Aconiti Kusnezoffii Preparat). Follow-up was carried out for the evaluation of the therapeutic effect of displaced intra-articular calcaneal fractures ( Sanders type Ⅱ, Ⅲ). Results Forty cases (involving 44 feet) received the postoperative follow-up for 12-18 months (average being 14.2 months). The Maryland foot scores were 95 points for type Ⅱ displaced intra-articular calcaneal fractures, and 86 points for type Ⅲ fractures. Satisfactory results were achieved in the height, width and length of the calcaneus as well as the B?hler's and Gissane angle ( P<0.01). Conclusion Minimally invasive retracter reduction and fixation through sinus tarsi approach together with external application of Chinese medicine exert satisfying effect for the treatment of displaced intra-articular calcaneal fractures.

The Sinus Tarsi Approach for the Treatment of Intra-Articular Calcaneal Fractures / 대한족부족관절학회지

Open reduction and internal fixation is currently considered as a gold standard of treatment in most of the intra-articular calcaneal fractures. Among various different approaches, extensile lateral approach is the most popular since it provides good exposure to the subtalar joint. However, wide skin incision followed by extensive soft tissue dissection leading to increased risk of wound breakdown is the most serious drawback. Sinus tarsi approach, a minimal invasive technique to approach the subtalar joint and reduce the intra-articular calcaneal fractures, provides good clinical outcome and less wound complications compared to the extensile lateral approach. This article introduces the surgical technique and review of the literature regarding the sinus tarsi approach.

The Operative Treatment using Mini-open Sinus Tarsi Approach for Displaced Intraarticular Calcaneal Fractures / 대한족부족관절학회지

PURPOSE: This study was performed to evaluate the clinical outcomes of operative treatment using mini-open sinus tarsi approach for displaced intraarticular calcaneal fractures. MATERIALS AND METHODS: We studied 18 cases (16 patients) of intraarticular calcaneal fractures who were treated with sinus tarsi approach by same surgeon. The mean age of patients was 44.8 years, and mean follow-up period was 17.2 months. The measurement of Bohler angle, Gissane angle, the degree of articular surface depression, and the period to union were performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). RESULTS: Bohler angle and Gissane angle had improved significantly from preoperative average 9.8degrees, 117.6degrees to average 22.4degrees, 113.4degrees immediate postoperatively, and had maintained to average 21.8degrees and 114.2degrees at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 5.2 mm to 1.2 mm at the last follow-up. All cases achieved bone union, and the period to union was average 10.5 weeks. AOFAS score was average 86.2 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the CNHF scale. Therefore, 16 cases (88.8%) achieved satisfactory results. CONCLUSION: The minimally invasive sinus tarsi approach using headless compression screw seems to be an effective surgical method for displaced intraarticular calcaneal fractures, because of the possibility of accurate restoration of articular surface and the low risk of postoperative soft tissue complications.

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

PURPOSE: To compare the clinical results between the extensile lateral approach and sinus tarsi approach in the open reduction of the Sanders type II calcaneal fracture. MATERIALS AND METHODS: From July 2002 to Februry 2007, thirty two patients having thirty three calcaneal fractures of Sanders type II were managed with open reduction and internal fixation using the extensile lateral approach or sinus tarsi approach. The mean age of 19 patients using extensile lateral approach was 43.3 years. The mean age of 13 patients using sinus tarsi approach was 46.3 years. Clinical outcome, radiographic parameters, and postoperative complications were compared between both groups. RESULTS: There was no difference between two groups associated with patients demographs. The mean AOFAS score and VAS between both groups were not different (p=0.716, p=0.774). The mean Bohler's angle and Gissane's angle between both groups were not different (p=0.343, p=0.357). Two cases of sural nerve injury, one malunion, and one deep infection were occurred in the group of extensile lateral approach. However, patients using sinus tarsi approach had no postoperative complications. CONCLUSION: The clinical results of sinus tarsi approach may be comparable with those of extensile lateral approach, with the advantages of reduced risk of postoperative complications.

Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients

PURPOSE: Wound problems occur in 5~30% of intra-articular calcaneal fractures following operation. Diabetes mellitus, large incisions and abundant dissection can increase the risk of wound problems that may require skin graft or other additional care. The authors used minimally invasive technique to treat intra-articular calcaneal fractures in diabetic patients and evaluated the results and complications of this method. MATERIALS AND METHODS: Between January 2002 and July 2005, 12 patients with intra-articular calcaneal fractures who had underlying diabetes mellitus were treated using minimally invasive technique with a modified sinus tarsi approach. The patients had an average age of 47 years (39~67) and were followed an average of 19 months (13~32). The mean period between injury and operation was 8 days (5~14). Crutch assisted partial weight bearing was advised for an average of 7.3 weeks (6~9) and full weight bearing was allowed after average of 9.3 weeks (7~11). RESULTS: According to AOFAS scale for ankle and hindfoot, patients had the following results: excellent - 1 patient (8%), good - 9 patients (75%), fair - 1 patient (8%), unsatisfied - 1 patient (8%). Bone union was achieved in all cases and there were no events of deep infection or skin necrosis. CONCLUSION: Treating intra-articular calcaneal fractures by minimally invasive technique is an excellent operative method for patients with diabetes mellitus, as this method can minimize soft tissue incision and resulting deep infection and skin necrosis.