Sinus Tarsi Approach for Calcaneal Fractures: A Single-Center Comparison of Early Versus Delayed Surgery by a...

Background The sinus tarsi approach (STA) is a well-established technique for treating displaced intra-articular calcaneal fractures (DIACFs) due to its reduced wound complication rates compared to the extensile lateral approach. However, concerns remain regarding the efficacy and safety of STA when performed beyond the 14-day post-injury mark. Objective The objective of this study was to evaluate and compare the radiological outcomes and complication rates between early (<14 days) and delayed (≥14 days) STA interventions. Methods This retrospective study was conducted at Hospital Queen Elizabeth II, Sabah, Malaysia. A total of 42 calcanea with DIACFs treated using STA from July 2022 to July 2025 were included. Patients were divided into early (12 calcaneum) and delayed (30 calcaneum) groups based on the timing of surgery. Pre- and postoperative Böhler and Gissane angles were measured and compared. Surgical duration and postoperative complications were analysed. As this was the first series of calcaneal fractures treated using the sinus tarsi approach at our center, all eligible cases (n=42) treated between July 2022 and July 2025 were included. Results The mean preoperative Böhler angle was 9.5°, and it improved postoperatively to 26.6°. The mean preoperative Gissane angle was 116.9°, and it improved to 131.0° postoperatively. No statistically significant differences were found between early and delayed groups for Böhler (p = 0.426) and Gissane angles (p = 0.746). Complication rates were 16.7% for early and 3.3% for delayed groups (p = 0.192). Mean operative time did not significantly differ between the early (107.7 mins) and delayed (113.4 mins) groups (p = 0.599). Conclusion The STA provided consistent radiographic outcomes in both early and delayed interventions. STA remains a safe and adaptable option in our centre, though larger prospective studies with functional outcome assessments are warranted to strengthen external validity.