Imke Richter1, Nicola Krähenbühl2, Roxa Ruiz1, Roman Susdorf1, Tamara Horn Lang1, Beat Hintermann1. 1. Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland. 2. Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland. nicola.kraehenbuehl@ksbl.ch.
Abstract
BACKGROUND: While the extended lateral approach was the gold standard for treatment of calcaneal fractures for decades, the mini-open approach through the sinus tarsi gained popularity in recent years. Although widely used, there are only a few reports available in the literature reporting on mid- to long-term results. Therefore, the purpose of the study was to report on mid- to long-term radiographic and clinical outcomes of calcaneal fractures treated surgically using a mini-open sinus tarsi approach. MATERIALS AND METHODS: In this retrospective review, radiographic and clinical outcome measures of 30 consecutive patients (34 fractures) were analyzed. Conventional radiographs were used to measure the Boehler's angle before and after surgical fixation. Computed tomography (CT) scans were analyzed to distinguish between joint depression and tongue-type calcaneal fractures. Each calcaneal fracture was additionally categorized according to the Sanders classification. The clinical outcome was measured using a 5-point Likert scale ranging from 0 (very unsatisfied) to 4 (very satisfied), the Visual Analog Scale (VAS) for pain, and the Maryland Foot Score. RESULTS: The Boehler's angle improved from 12.6 degrees preoperatively to 26.3 degrees postoperatively (P < 0.001). Loss of sagittal reduction (i.e., a decline of the Boehler's angle of > 5 degrees) from postoperative to the last follow-up was evident in nine (26%) fractures. Out of 29 patients with an available satisfaction score, 20 (69%) were very satisfied, 8 (28%) were satisfied, and one (3%) was moderately satisfied. Satisfaction at the last follow-up declined with higher age at surgery. An overall low complication rate was evident, with painful hardware needing removal being the most common complication. CONCLUSIONS: Approaching calcaneus fractures through the sinus tarsi provides satisfactory mid- to long-term radiographic and clinical outcomes, independent of the severity of the fractures according to the Sanders classification. LEVEL OF EVIDENCE: Level IV, Retrospective Case Series.
BACKGROUND: While the extended lateral approach was the gold standard for treatment of calcaneal fractures for decades, the mini-open approach through the sinus tarsi gained popularity in recent years. Although widely used, there are only a few reports available in the literature reporting on mid- to long-term results. Therefore, the purpose of the study was to report on mid- to long-term radiographic and clinical outcomes of calcaneal fractures treated surgically using a mini-open sinus tarsi approach. MATERIALS AND METHODS: In this retrospective review, radiographic and clinical outcome measures of 30 consecutive patients (34 fractures) were analyzed. Conventional radiographs were used to measure the Boehler's angle before and after surgical fixation. Computed tomography (CT) scans were analyzed to distinguish between joint depression and tongue-type calcaneal fractures. Each calcaneal fracture was additionally categorized according to the Sanders classification. The clinical outcome was measured using a 5-point Likert scale ranging from 0 (very unsatisfied) to 4 (very satisfied), the Visual Analog Scale (VAS) for pain, and the Maryland Foot Score. RESULTS: The Boehler's angle improved from 12.6 degrees preoperatively to 26.3 degrees postoperatively (P < 0.001). Loss of sagittal reduction (i.e., a decline of the Boehler's angle of > 5 degrees) from postoperative to the last follow-up was evident in nine (26%) fractures. Out of 29 patients with an available satisfaction score, 20 (69%) were very satisfied, 8 (28%) were satisfied, and one (3%) was moderately satisfied. Satisfaction at the last follow-up declined with higher age at surgery. An overall low complication rate was evident, with painful hardware needing removal being the most common complication. CONCLUSIONS: Approaching calcaneus fractures through the sinus tarsi provides satisfactory mid- to long-term radiographic and clinical outcomes, independent of the severity of the fractures according to the Sanders classification. LEVEL OF EVIDENCE: Level IV, Retrospective Case Series.
Entities:
Keywords:
Calcaneal fracture; Mini-open approach; Sanders classification; Sinus tarsi approach
Authors: Charles C Pitts; Adam Almaguer; John T Wilson; Jonathan H Quade; Michael D Johnson Journal: Foot Ankle Int Date: 2019-05-14 Impact factor: 2.827