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Comparison of sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fractures Sanders type IV

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Abstract

Purpose

Displaced intra-articular calcaneus fractures Sanders type IV(DIACFS IV) can result in an unsatisfactory prognosis and a high complication rate. Our investigation intends to compare the outcomes of DIACFS IV treated by open reduction and internal fixation (ORIF) via sinus tarsi approach (STA) with these via extensile lateral approach (ELA).

Methods

Sixty-nine patients (82 ft) with DIACFS IV who were treated with ORIF (29 in STA group and 40 in ELA group) were retrospectively assessed. Median follow-up was 50 months in two groups. Radiographic results were reviewed pre-operatively and post-operatively, and relative complications were collected. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale (VAS).

Results

The wound-healing complication rate was 14.28% in STA group and 34.04% in ELA group (p = .043), and overall complication rate was 54% and 77% (p = .056), respectively. Seven cases of sural nerve injury only occurred in ELA group. The post-operative radiographs of the calcaneus (Böhler’s angle, height, width, and length) were significantly different from those measured pre-operatively in each group. And these data were parallel between the two groups. In STA and ELA groups, the average AOFAS was 75.45 versus 72.44 (p = .496), and the mean VAS was 23.95 versus 30.93 (p = .088), respectively.

Conclusion

Similar clinical and radiographic outcomes are achieved between STA and ELA. And STA has a lower incidence of wound healing complication and sural nerve injury. Therefore, ORIF via STA can be a considerable management for DIACFS IV.

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There are no financial activities related to the submitted work.

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Author notes

  1. Jinti Lin and Chenglong Xie contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, China

    Jinti Lin, Chenglong Xie, Kai Chen, Shuaibo Sun, Kailiang Zhou, Chengwei Zhou, Xiaolong Shui & Jianzhong Kong

  2. The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, 325027, China

    Jinti Lin, Chenglong Xie, Kai Chen, Shuaibo Sun, Kailiang Zhou, Chengwei Zhou, Xiaolong Shui & Jianzhong Kong

  3. Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109 W Xueyuan Road, Wenzhou, 325000, Zhejiang, China

    Xiaolong Shui & Jianzhong Kong

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  1. Jinti Lin
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Correspondence to Xiaolong Shui or Jianzhong Kong.

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Our research was approved by the ethics department of The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang. We have consensus with all participants. We also followed the Declaration of Helsinki and relevant policies in China.

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Lin, J., Xie, C., Chen, K. et al. Comparison of sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fractures Sanders type IV. International Orthopaedics (SICOT) 43, 2141–2149 (2019). https://doi.org/10.1007/s00264-019-04318-w

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