Wound complications following calcaneal fracture surgery using sinus tarsi approach

The sinus tarsi approach (STA) has gained popularity as a minimally invasive alternative to the extensile lateral approach for displaced intra-articular calcaneal fractures (DIACFs), yet wound complications remain a concern. This study aimed to determine the incidence and predictors of wound complications following STA fixation.

A retrospective multicenter cohort study was conducted across four tertiary referral hospitals, including all surgically treated DIACFs managed with STA between 2018 and 2022. Demographic, injury-related, and operative variables were extracted from medical records. The primary outcome was wound complications within eight postoperative weeks, defined as inflammation, necrosis, or persistent wound leakage >2 weeks. Secondary outcomes included reoperation and identification of risk factors.

148 fractures in 143 patients were included. Wound complications occurred in 13 cases (9%), with only one requiring surgical revision; eight were treated with antibiotics. Reoperation within one year occurred in 10% of cases, with a higher, though not statistically significant, rate among patients with wound complications (21% vs. 7.5%). Significant risk factors for wound complications were psychiatric comorbidity (p = 0.012), open fractures (p = 0.032), and concomitant fractures (p = 0.021). Trends toward higher complication rates were observed with screw fixation and Sanders type III-IV fractures. No associations were found with smoking, diabetes, alcohol use, or time to surgery.

STA for DIACFs is associated with a low wound complication rate, with few cases requiring reoperation. Open fractures, psychiatric disorders, and concomitant injuries significantly increase the risk of wound complications, whereas traditional risk factors known from extensile approaches-such as smoking and diabetes-were not associated with adverse outcomes. These findings support the safety of STA and highlight the importance of recognizing patient- and injury-related risk factors in perioperative planning.