Extended Subtalar Approach in the Surgical Treatment of Depressed Intra-Articular Calcaneus Fractures With Depression of the Medial Fragment of the Posterior Facet.

Abstract

Background: Several alternative incisions have been developed for the surgical treatment of calcaneus fractures, including the extensile lateral approach, medial approach, combined lateral and medial approach, limited posterolateral approach, and sinus tarsi approach. This study aimed to describe a modified approach in which we extended the sinus tarsi approach and examined the reduction success in intra-articular fractures involving the medial column.

Methods: Patients with calcaneus fracture surgery between 2017 and 2021 were reviewed retrospectively. Computed tomography was obtained immediately after surgery and 6 months later to measure calcaneal anatomical parameters such as Böhler's angle, Gissane's angle, height, and width. Preoperative and postoperative radiologic measurements, soft-tissue complications, sural nerve damage, quality of posterior facet reduction, and other complications were recorded. The obtained data were used in the statistical analysis.

Results: The mean ± SD age was 30.92 ± 9.61 years. Based on the Sanders classification, eight fractures were type 3 and five were type 4. In preoperative and postoperative measurements, there was a statistical difference in Gissane's angle (P = .001), Böhler's angle (P = .001), calcaneal height (P = .001), and calcaneal width (P = .039).

Conclusions: Extending the sinus tarsi approach may provide adequate visualization and control of fracture fragments in Sanders type 3 and 4 fractures in which the medial articular surface of the posterior facet is depressed.