Increased Lateral Calcaneal Body and Subtalar Joint Visualization Utilizing a Modified Sinus Tarsi Approach

Area of Science:

• Orthopedic Surgery
• Anatomy
• Surgical Technique

Background:

• The traditional sinus tarsi approach (TST) is favored for calcaneus fracture fixation due to adequate exposure and low complication rates.
• However, TST visualization can be limited compared to more extensive surgical methods.
• A modified sinus tarsi approach (MST) is proposed to enhance exposure by extending the TST incision.

Purpose of the Study:

• To quantitatively compare the surgical exposure provided by the traditional sinus tarsi approach (TST) and the modified sinus tarsi approach (MST).
• To assess the potential benefits of MST for calcaneus fracture treatment.

Main Methods:

• Twelve cadaveric specimens were dissected sequentially using both TST and MST.
• Exposed calcaneal areas (lateral wall, posterior facet, dorsal surface) were measured using digital imaging.
• The proximity of the sural nerve to the MST incision was recorded.

Main Results:

• The MST significantly increased the exposed surface area of the lateral calcaneal wall, posterior facet, and dorsal surface compared to the TST (P < .0001).
• MST provided substantially greater coverage of these critical calcaneal areas.
• The sural nerve was located very close to the distal extent of the MST incision on average.

Conclusions:

• The modified sinus tarsi approach (MST) offers significantly enhanced visualization of calcaneal surfaces compared to the traditional sinus tarsi approach (TST).
• This improved exposure may lead to better outcomes in calcaneus fracture reduction and fixation.
• Caution is advised regarding the sural nerve's proximity to the MST incision.