A COMPARATIVE STUDY OF CALCANEAL FRACTURES MANAGED BY SINUS TARSI APPROACH AND EXTENSILE LATERAL APPROACH- IN TERMS OF CLINICO-RADIOLOGICAL AND FUNCTIONAL OUTCOME
Main Article Content
Keywords
Calcaneal Fractures, Sinus Tarsi Approach, Extensile Lateral Approach, AOFAS Score, Functional Outcome, Sanders Classification
Abstract
Background: Calcaneal fractures account for 60% of tarsal fractures, with displaced intra-articular fractures requiring surgical intervention. The optimal surgical approach remains debated between the Sinus Tarsi Approach (STA) and Extensile Lateral Approach (ELA). This study compared clinical, radiological, and functional outcomes of both techniques to guide surgical decision-making.
Methods: A prospective comparative study was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, over 18 months. Sixty patients with Sanders Type II and III calcaneal fractures were randomized into two groups (n=30 each) receiving either STA or ELA. Preoperative assessments included radiological evaluation and CT scans. Follow-ups at 6, 12, and 24 weeks assessed pain (VAS score), functional recovery (AOFAS and Maryland Foot Scores), radiological alignment (Böhler and Gissane angles), wound healing, and complications. Statistical analysis used SPSS with p<0.05 considered significant.
Results: The STA group demonstrated significantly shorter operative time (65.5±10.2 vs 85.3±12.4 minutes, p=0.001), reduced hospital stay (4.2±1.1 vs 6.5±1.3 days, p=0.001), and better pain control at 24 weeks (VAS 0.5±0.6 vs 1.2±1.1, p=0.001). Wound complications were lower in STA (0% dehiscence vs 8.3% in ELA). Both approaches achieved significant radiological improvements, with ELA showing marginally better Böhler (28.5±3.2° vs 27.8±3.1°) and Gissane angles (130.2±3.8° vs. 128.5±3.6°). Functional outcomes favored STA, with superior AOFAS (91±4.9 vs 90±5.5) and Maryland Foot Scores (90±4.3 vs 89±5.2) at 24 weeks (p=0.001). Earlier weight-bearing (8.2±1.5 vs 10.5±1.8 weeks) and faster return to work (12.5±2.1 vs 15.2±2.5 weeks) were observed with STA (p=0.001).
Conclusion: While both approaches effectively manage calcaneal fractures, STA offers superior outcomes in operative efficiency, pain management, wound healing, and functional recovery. ELA remains preferable for complex fractures requiring extensive exposure.
References
[2] Bibbo C, Siddiqui N, Fink J, et al. Wound coverage options for soft tissue defects following calcaneal fracture management (Operative/Surgical). Clin Podiatr Med Surg 2019;36(2):323-37.
[3] Cottom JM, Douthett SM, McConnell KK. Intraoperative Reduction Techniques for Surgical Management of Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Sur 2019;36(2):269-77.
[4] Buckley RE, Tough S. Displaced intra-articular calcaneal fractures. J Am Acad Orthop Surg 2004;12(3):172-8.
[5] Buckley R, Tough S, McCormack R, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicentre trial. J Bone Joint Surg Am 2002;84:1733-44.
[6] Lee KB, Chung JY, Song EK, et al. Arthroscopic release for painful subtalar stiffness after intra-articular fractures of the calcaneum. J Bone Joint Surg Br 2008;90:1457-61.
[7] Attenasio A, Heiman E, Hong IS, et al. Postoperative wound complications in extensile lateral approach versus sinus tarsi approach for calcaneal fractures: are we improving? Updated meta-analysis of recent literature. Injury 2024;111560.
[8] Fadle AA, Khalifa AA, Shehata PM, et al. Extensible lateral approach versus sinus tarsi approach for Sanders type II and III calcaneal fractures osteosynthesis: a randomized controlled trial of 186 fractures. J Orthop Surg Res 2025;20(1):8.
[9] Sangeorzan BJ, Benirschke SK, Carr JB. Surgical management of fractures of the oscalcis. Instr Course Lect Am Acad Orthop Surg 2005;54:45-52.
[10] Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349-53.
[11] Zeng Z, Yuan L, Zheng S, et al. Minimally invasive versus extensile lateral approach for Sanders type II and III calcaneal fractures: a meta-analysis of randomized controlled trials. Int J Surg 2018;50:146-53.
[12] Syros A, Perez J, Hodgens BH, et al. Sinus tarsi approach in high-risk patients with displaced intra-articular calcaneus fractures: a case series. Journal of Orthopaedics 2022;34:282-7.
[13] Luo L, Chen J, An Z, et al. Efficacy and postoperative complication rates of different surgical approaches for calcaneal fractures: a network meta-analysis. Alternative Therapies in Health & Medicine 2024;30(7).
[14] Weber M, Lehmann O, Sägesser D, et al. Limited open reduction and internal fixation of displaced intraarticular fractures of the calcaneum. J Bone Joint Surg Br 2008;90:1608-16.
[15] Basile A, Albo F, Via AG. Comparison between sinus tarsi approach and extensile lateral approach for treatment of closed displaced intra-articular calcaneal fractures: a multicenter prospective study. J Foot Ankle Surg 2016;55:513-21.
[16] Batar S, Karataş ME, Kaya Y, et al. Comparative analysis of lateral extensile approach and sinus tarsi approach in the surgical treatment of calcaneal fractures: a retrospective study. Ann Clin Anal Med 2024;15(9):650-5.
[17] Ersin M, Demirel M, Ekinci M, et al. Comparison of sinus tarsi approach versus extensile lateral approach in the management of displaced intra-articular calcaneal fractures: a single-center study. Turkish Journal of Trauma & Emergency Surgery 2023;29(9):1061-7.
[18] Fan B, Zhou X, Wei Z, et al. Cannulated screw fixation and plate fixation for displaced intra-articular calcaneus fracture: a meta-analysis of randomized controlled trials. Int J Surg 2016;34:64-72.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Mohd. Bilal Kaleem
Assistant Professor, Department of Orthopaedics, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India.
Dr. Arpit Vishnoi
Assistant Professor, Department of Orthopaedics, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India.
Dr. Pranjal Khatri
Junior Resident, Department of Orthopaedics, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India.
Dr. Kunal Vij
Professor, Department of Orthopaedics, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India.