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The use of medial stabilization and the sinus tarsi approach to treat Sanders type II and III calcaneal fractures

The aim of this study was to assess the clinical outcomes of surgical treatment for displaced intraarticular calcaneal fractures using a mini-fragment locking plate, via the modified sinus tarsi approach. In this retrospective study, 16 patients (13 men and 3 women) with 16 displaced intra-articular calcaneal fractures were included. A modified sinus tarsi approach was used to reduce and stabilize the posterior facet. This was done using the raft technique with a mini-fragment locking plate, and multiple sagittal screws were added percutaneously, to stabilize the calcaneal body and control rotation. Intra-operative three-dimensional computed tomography was routinely performed to evaluate the reduction and screw placement. The pre- and postoperative Böhler and Gissane angles were compared. The mean duration of follow-up was 18.4 months. The mean union time was 10 weeks. The mean preoperative Böhler angle (13.4° ± 3.0°) and Gissane angle (88.1° ± 4.5°) were significantly increased (P<0.05) at the final follow-up (26.5° ± 5.4° and 116.2° ± 7.7°, respectively). The mean postoperative AOFAS and SF-36 scores were 83.3 and 79.5, respectively. Complications included two cases of moderate subtalar joint stiffness. No wound edge necrosis, superficial or deep infection, or nerve injury was observed in these patients. The application of minimally invasive raft technique using a mini-fragment locking plate combined with percutaneous screw fixation is an effective option for treating displaced Sanders type II and III intraarticular calcaneal fractures.

Author(s): Jian Zou, Zhongmin Shi, Jianfeng Xue, Wenqi Gu, Guohua Me, Xiaolin Li