A Stepwise Minimally Invasive Sinus Tarsi Approach to Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: Technique Tip.

Abstract

The calcaneus is the most commonly fractured tarsal bone in the setting of polytrauma, with a 17% prevalence in patients presenting with foot injuries.19 Displaced intraarticular calcaneal fractures (DIACF) can be highly disabling injuries if left untreated.21 Appropriate surgical management with open reduction and internal fixation (ORIF) has been associated with good outcomes regardless of fracture pattern, or patient characteristics.8,13 In particular, accurate subtalar anatomic joint reduction and restoring the Böhler angle are key features to improved functional outcomes and lower rates of secondary subtalar arthrodesis. However, ORIF can be difficult in complex cases with comminuted intercalary fragments.16 The extensile lateral approach (ELA) has been the gold standard for calcaneal ORIF because of the wide surgical exposure and ease of manipulation of fracture fragments.4 However, it has been associated with significant wound complications, limiting its advantage over nonoperative treatment in different trials.4,9,10 On the other hand, the sinus tarsi approach (STA) is gradually becoming the standard surgical approach for calcaneal ORIF.17 Recent data showed good functional and radiographic outcomes, with low morbidity and low rates of wound complications, making it one of the preferred surgical approaches among foot and ankle surgeons.7,11,20 However, the STA, with its narrow field of exposure, can represent a challenge to inexperienced surgeons dealing with complex intra-articular fractures of the calcaneus, leading to inferior quality of reduction.6 The current article will describe a step-by-step technical note to successful ORIF of DIACF using a minimally invasive STA. Surgical Technique