Limited sinus tarsi approach versus extended lateral L-shaped approach for the open reduction and internal fixation of Sanders type III calcaneal fractures: a retrospective study

Abstract Purpose Controversy still exists regarding whether the sinus tarsi approach is able to effectively manage the Sanders type III fractures. The objective of this retrospective study was to describe and evaluate the clinical applications of the minimally invasive sinus tarsi approach and the extended lateral L-shaped approach for treating Sanders type III calcaneal fractures. Methods Between January 2012 and February 2015, 35 patients with calcaneal fractures(Sanders type III)treated in our trauma center were enrolled in this retrospective study. Surgeries were performed after improvement of soft tissue conditions. Either limited ORIF via sinus tarsi approach (minimally invasive group) or traditional ORIF via extended lateral L - shaped approach (traditional group) was performed on these patients. Clinical evaluation indicators including time to surgery, time for surgery, complications, subtalar joint stiffness, traumatic arthritis, SF-36, VAS, AOFAS score, Böhler's angle as well as Gissane's angle were recorded and compared between these two groups. Results The waiting time before surgery in minimally invasive group was significantly shorter than that in the traditional group. The mean operative time was significantly higher than that in the traditional group. No significant difference with respect to the AOFAS score, VAS score and SF-36 score between the groups was manifested. Subtalar stiffness occurred in 3 cases in the minimally invasive group, while 7 cases in the traditional group. 2 cases in traditional group and one case in the minimally invasive group presented with subtalar traumatic arthritis and the symptoms subsided after treatment. The difference regarding the Böhler angle and Gissane angle between groups were not statistically significant. Conclusion With the lower incidence of soft tissue complications and subtalar joint stiffness, minimally invasive treatment of calcaneal Sanders III fracture through the trans-tarsal sinus incision can be performed as one of the routine options.