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Sinus tarsi approach for sanders type IV calcaneal fractures: Midterm radiographic, functional and complication
Onur Suer1, Recep Selcuk Eyceyurt1, Meliksah Uzakgider1
1Department of Orthopedics and Traumatology, Izmir City Hospital, Izmir, Türkiye.
Background:
Sanders type IV displaced intra-articular calcaneal fractures are associated with severe comminution and poor outcomes. Evidence on the sinus tarsi approach remains limited.
Purpose:
To evaluate radiographic restoration, functional outcomes, and complications after the sinus tarsi approach for Sanders type IV calcaneal fractures.
Study Design:
Retrospective single-center case series.
Methods:
We retrospectively reviewed a consecutive series of patients treated operatively using the sinus tarsi approach between January 2014 and January 2024. After predefined exclusions, 51 Sanders type IV fractures with minimum 24-month follow-up were included. Böhler angle, Gissane angle, calcaneal height, and calcaneal length were measured preoperatively, early postoperatively, and at final follow-up. Final pain and function were assessed using the visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Complications and reoperations were recorded.
Results:
Mean age was 45.5 ± 16.5 years, median time to surgery was 5 days, and mean follow-up was 58.2 ± 27.9 months. All radiographic parameters improved significantly over time (all p < 0.001). Böhler angle improved from -6.4 ± 9.8 degrees preoperatively to 22.4 ± 7.3 degrees early postoperatively and was 20.4 ± 7.4 degrees at final follow-up. Median final VAS and AOFAS hindfoot scores were 2 and 81, respectively. Reoperation was required in 7 patients (14%). No deep infection, malunion, or nonunion occurred.
Conclusion:
The sinus tarsi approach was associated with satisfactory midterm radiographic and functional outcomes and acceptable complication and reoperation rates in Sanders type IV calcaneal fractures. Prospective comparative studies are needed to better define its role.