Clinical comparison of modified sinus tarsi approach and L-shaped approach in open reduction and internal fixation for Sanders typeIII-IV intra-articular calcaneal fractures: Complications, security, effectiveness analysis.

Background: L-shaped incision is the most widely used approach for treating calcaneal fracture; however, it has been associated with various complications, such as wound infection, skin edge necrosis, postoperative fracture malunion, and traumatic arthritis. Accordingly, this surgical approach should be re-examined. This study aimed to investigate the clinical effect and safety of the modified sinus tarsi approach in open reduction and internal fixation for Sanders type III-IV calcaneal fractures and compare it with the traditional L-shaped approach.

Methods: This retrospective study enrolled 72 patients with unilateral closed Sanders type III-IV calcaneal fractures treated with a modified sinus tarsi approach (38 patients) and L-shaped approach (34 patients) from May 2018 to June 2020. Postoperative complications and changes in calcaneal Böhler angle, Gissane angle, and Varus angle were observed and compared between the two groups before and 3 days, and 12 months after the operation. At 12 months after the operation, the Maryland foot function score, AOFAS score, and VAS score were used to evaluate the recovery of foot function in both groups.

Results: The modified tarsal sinus approach group had significantly shorter incision healing time (9.8 ± 1.9 d) and operation time (75.53 ± 21.12 min), as well as fewer wound-healing complications (2.6 %) compared to the L-shaped approach group (P < 0.05). There were no significant differences in the Böhler, Gissane, and Varus angles between the two groups after the operation. At 12 months after the operation, no significant differences were observed in Maryland, AOFAS, and VAS scores.

Conclusion: The modified sinus tarsi and L-shaped approaches had similar clinical effects in the treatment of Sanders type III-IV calcaneal fractures. However, the treatment of modified sinus tarsi approaches in open reduction and internal fixation for Sanders type III-IV calcaneal fractures implies small incision, low degree of soft tissue injury, and low wound-healing complications, thus resulting in an effective minimally invasive treatment for Sanders type III-IV calcaneal fractures.