The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review

Abstract

Purpose: Although open reduction and internal fixation is currently considered the gold standard in surgical treatment of displaced intra-articular calcaneal fractures, various different approaches exist including the limited lateral approach. The aim of this systematic review was to combine the results of studies using the sinus tarsi approach, which is the most frequently applied limited lateral approach.

Method: A literature search in the electronic databases of the Cochrane Library and Pubmed Medline, between January 1st 2000 to December 1st 2010, was conducted to identify studies in which the sinus tarsi approach or a modified sinus tarsi approach was utilized for the treatment of displaced intra-articular calcaneal fractures. The methodological quality of the included studies was assessed using the Coleman methodology score.

Results: A total of eight case series reporting on 256 patients with 271 calcaneal fractures was identified. Overall good to excellent outcome was reached in three-quarters of all patients. An average complication rate of minor wound complications of 4.1% was reported and major wound complications in 0.7%. The need for a secondary subtalar arthrodesis occurred at an average rate of 4.3%. The average Coleman methodology score was 56.8 (range 39-72) points.

Conclusion: The results, i.e. functional outcome and complication rates, of the sinus tarsi approach compare similarly or favourably to the extended lateral approach. Therefore, in the process of tailoring the best treatment modality to the right patient and the right fracture type, the sinus tarsi approach might be a valuable asset.

Fig. 1

Example of displaced intra-articular calcaneal fracture treated via sinus tarsi approach. a Pre-operative radiograph with Böhler angle of 7.5°. b Skin marking of sinus tarsi incision. c Per-operative view with lamina spreader and provisional K-wire fixation. d Post-operative radiograph with Böhler angle of 22.5°

Fig. 2

Sanders classification. Line drawing of a semi-coronal image of the calcaneus showing all three fracture lines (A, B, C)

Fig. 3

Extended lateral approach versus sinus tarsi approach. Lateral radiograph with superimposed line drawings of approaches and nerves. a Extended lateral approach. b Sinus tarsi approach. 1 Sural nerve. 2 Superficial peroneal nerve