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Sinus Tarsi Versus Extensile Lateral Approach For Calcaneal Fractures - A Multicenter Study
Thomas M Seaver1, Zachary Zeller, Paul Tornetta
1From the Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA (Dr. Zeller and Dr. Tornetta); the Lahey Medical Center, Department of Orthopedic Surgery, Burlington, MA (Dr. Marcantonio and Mr. Ment); Department of Orthopedic Surgery, the Florida Orthopaedic Institute, Tampa, FL (Dr. Mir and Dr. McCaskey); Department of Orthopedic Surgery, the University of Alabama at Birmingham, Birmingham, AL (Dr. Messner and Dr. Spitler); Department of Orthopedic Surgery, the Washington University in St. Louis, St Louis, MO (Dr. Hofer and Dr. Miller); the Hennepin County Medical Center, Minneapolis, MN (Mr. Westberg and Dr. Downes), Department of Orthopedic Surgery; Department of Orthopedic Surgery, the Metro Health Medical Center, Cleveland, OH (Dr. Joseph); Department of Orthopedic Surgery, the University of North Carolina, Chapel Hill, NC (Dr. Suh and Dr. Ostrum); Department of Orthopedic Surgery, the University of Nottingham, Nottingham, UK (Dr. Ollivere and Dr. Ikram); Department of Orthopedic Surgery, the Indiana University, Indianapolis, IN (Dr. Mullis and Dr. Figueras); Department of Orthopedic Surgery, the Oregon Health Science University, Portland, OR (Dr. Friess and Ms. Sodders); Department of Orthopedic Surgery, the Stanford University, Palo Alto, CA (Dr. Van Rysselberghe and Dr. Gardner); Department of Orthopedic Surgery, the Stony Brook University, Stony Brook, NY (Dr. Pawlak and Dr. Kottmeier); Department of Orthopedic Surgery, the University of California San Francisco, San Francisco, CA (Dr. Morshed); Department of Orthopedic Surgery, the Harborview Medical Center, Seattle, WA (Dr. Goodnough, Dr. Bunzel, and Dr. Firoozabadi); Department of Orthopedic Surgery, the University of Minnesota, Minneapolis, MN (Dr. Yoon and Mr. Pottinger); Department of Orthopedic Surgery, the Case Western Reserve University, Cleveland, OH (Dr. Vallier); Department of Orthopedic Surgery, the Hughston Clinic, Nashville, TN (Dr. Hofer); Department of Orthopedic Surgery, the SUNY Downstate Health Sciences University, Brooklyn, NY (Dr. Malik); Department of Orthopedic Surgery, the Orillia Soldiers' Memorial Hospital, Orillia, Canada (Dr. Lim); Department of Orthopedic Surgery, the University of Arizona, Phoenix, AZ (Dr. Johnson and Mr. Chaliki); and the Sanford Medical Center, Department of Orthopedic Surgery, Fargo, ND (Dr. Seaver).
Introduction:
The optimal surgical approach for intraarticular calcaneal fractures remains debated. This study compares deep infection rates between the extended lateral (EL) and sinus tarsi (ST) approaches.
Methods:
A retrospective review was conducted of 782 patients treated surgically for OTA 82B/C calcaneal fractures across 15 institutions. Deep infection was defined as requiring surgical débridement or treatment for osteomyelitis. Risk factors were identified using univariate and multivariate analyses.
Results:
Of 782 fractures, 444 were treated with EL and 338 with ST. Deep infections occurred in 6.8% of EL and 3.0% of ST cases (P = 0.017). Multivariate analysis found that surgical approach (P = 0.03) and age (P < 0.001) were independent risk factors. EL had more wound complications; ST had more symptomatic implants.
Conclusion:
The ST approach was associated with lower rates of deep infection and wound complications, even in higher-risk patients.
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