Sinus Tarsi Versus Extensile Lateral Approach for Sanders Type II-IV Calcaneal Fractures: A Comparative Analysis of...

Background/Objectives: The optimal surgical approach for displaced intra-articular calcaneal fractures (DIACFs) remains controversial. While the extensile lateral approach (ELA) has traditionally been preferred for complex fractures, the sinus tarsi approach (STA) has gained popularity due to its potentially lower soft tissue morbidity. However, comparative data focusing on patient-centered outcomes remain limited. This study aimed to compare clinical, radiological, functional, cosmetic, and complication outcomes between STA and ELA in Sanders type II-IV DIACFs. Methods: A retrospective comparative cohort study was conducted including patients treated with open reduction and internal fixation using either STA or ELA between February 2019 and October 2024. Functional outcomes were assessed using the AOFAS Ankle-Hindfoot Score and VAS. Radiological evaluation included Böhler and Gissane angles measured preoperatively, early postoperatively, and at final follow-up. Patient-centered outcomes included time to full weight bearing, return to work, heel width difference, and changes in shoe size. Complications were recorded throughout follow-up. Results: Baseline demographic and fracture characteristics were comparable between groups. Patients treated with STA demonstrated significantly shorter hospital stay, earlier progression to full weight bearing, and earlier return to work (p < 0.001). Functional outcomes favored STA, with significantly lower VAS scores and higher AOFAS scores at final follow-up (p < 0.05). No significant differences were observed between groups regarding Böhler or Gissane angles at any time point (p > 0.05). Wound-related complications were significantly more frequent in the ELA group (p = 0.018), although overall complication rates were comparable. Conclusions: The sinus tarsi approach was associated with comparable radiological restoration to the extensile lateral approach while demonstrating earlier functional recovery and lower wound-related morbidity. Given the retrospective and non-randomized design, these findings should be interpreted as associations rather than causal effects. STA may represent a safe and effective surgical option in appropriately selected Sanders type II-IV intra-articular calcaneal fractures.