Minimally invasive fixation with a locking plate for Sanders Ⅱ and Ⅲ calcaneal fractures via the tarsal sinus approach

Yongjie ZHAO; Guofeng GUAN; Gang YIN; Rui DU; Ying LIU

ABSTRACT

Objective:

To evaluate the minimally invasive fixation with a locking plate via the tarsal sinus approach in the surgical treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.

Methods:

A retrospective study was conducted to analyze the 65 patients who had been surgically treated for Sanders Ⅱ and Ⅲ calcaneal fractures at Department of Foot and Ankle Surgery, Binzhou Medical College Hospital from April, 2019 to September, 2020. There are 44 males and 21 females with an age of (42.5±10.4) years, and 46 Sanders type Ⅱ fractures and 19 Sanders type Ⅲ ones. The patients were divided into group L and group S according to surgical methods. Group S of 35 cases was fixated with a minimally invasive locking plate through the tarsal sinus incision while group L of 30 cases fixated with a locking plate through the L-shaped incision. The 2 groups were compared in terms of waiting time before surgery, surgical time, hospital stay, intraoperative bleeding, visual analogue scale (VAS) at 3 days after surgery, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at 1 year after surgery, excellent and good rate by the Maryland foot function score, B?hler angle, Gissane angle, varus angle, and complications.

Results:

There was no significant difference in the general data before surgery between the 2 groups, showing comparability ( P>0.05). All patients were followed up for (13.3±1.6) months after surgery. The waiting time before surgery [(2.8±1.8) d], surgical time [(80.7±9.9) min], hospital stay [(6.7±1.9) d], intraoperative bleeding [(54.3±14.2) mL], and VAS at 3 days after surgery [6 (5, 7) points] in group S were all significantly less or lower than those in group L [(8.2±2.8) d, (105.0±15.7) min, (14.6±3.4) d, (74.3±12.8) mL, and 7 (6, 8) points] (all P<0.05). At one year after surgery, the AOFAS ankle-hindfoot score [(90.1±3.5) points] in group S was significantly higher than that in group L [(83.5±6.7) points] ( P<0.05), but there was no statistically significant difference in the excellent and good rate by the Maryland foot function score between the 2 groups [91.4% (32/35) versus 86.7% (26/30)] ( P=0.695). The B?hler angle, Gissane angle, and varus angle were significantly improved in all patients one year after surgery compared with the values before surgery ( P<0.05), but there were no statistically significant differences within either group or between the 2 groups at 3 days or 1 year after surgery ( P>0.05). Peroneal muscle pain was reported in 1 case in group S; there were 2 cases of skin necrosis, 1 case of incision hematoma and 1 case of sural nerve injury in group L.

Conclusion:

The minimally invasive fixation with a locking plate via the tarsal sinus approach is an effective treatment for Sanders Ⅱ and Ⅲ calcaneal fractures.