Comparison of sinus tarsi approach and conventional extensile L shape approach in the management of Sanders type III calcaneal fractures / 中华骨科杂志

ABSTRACT

Objective This study is aimed to compare sinus tarsi approach and conventional extensile L shape approach in the management of Sanders type III calcaneal fractures. Methods A total of 36 cases of Sanders type III calcaneal fractures treated in our hospital between August 2011 to February 2014(35 patients, 27males, 8 females. Nineteen of them were performed a limited open reduction and internal fixation(ORIF) via the sinus tarsi approach(as minimal invasive group), while the other 17 cas?es were performed ORIF via conventional lateral extensile L shape approach(as conventional group). X?ray films were taken post?operatively to record the changes of B?hler angle and Gissane angle. The AOFAS ankle hind?foot scale, visual analogue scale and the MOS item short from health survey(SF?36) were adopted to assess the therapeutic effect. Results The average follow?up peri?od of minimal invasive group was 14.6 months. And conventional group were followed up for average period of 18.3 months. All the fractures in the series had a boney union at or before the final follow?up. The immediate correction and final correction of B?hler angle and Gissane angle were significantly increased in both minimal invasive group and conventional group, while there was sig?nificant difference between the two groups. The median AOFAS score ,VAS score and SF?36 score of the minimal invasive group were 84.74±8.14,1.68±0.95 and 89.36±4.69, while those in the conventional group were 82.06±10.95,1.94±1.43and 86.71±5.39. There was no significant statistically difference between the two groups. No wound problem happened in the minimal invasive group, 3 cases of subtalar joint stiffness were found, and 1 developed traumatic arthritis. Respectively, 2 cases in conventional group got hematoma and dehiscence for each, 8 cases of subtalar joint stiffness were found, and 2 cases developed traumatic arthri?tis finally. Conclusion Limited ORIF via a sinus tarsi incision have the familiar therapeutic effects to ORIF via a conventional extensile L shape incision in the management of type III calcaneal fractures. But the former has the advantage of lower incision complication rate and lower stiffness subtalar joint rate.