Sinus tarsi approach with trans-articular fixation for displaced intra-articular fractures of the calcaneus

The charts and radiographs of 99 patients with 106 intraarticular fractures of the calcaneus were retrospectively reviewed. There were 75 men and 24 w omen. The average age was forty-two (range, 17 to 81). Fifty-seven of the f ractures were left and 49 were right. The mechanism of injury was a fall fr om a height in 69 patients and motor vehicle accident in 30 patients. Accor ding to Sanders classification, seventy-one cases (67%) had type II fractur es, 25 cases (23.6%) had type III, and ten cases (9.4%) had type IV. All th e patients had operative management through a limited sinus tarsi approach with minimal fixation of the fracture with one or several pins. One of the pins was usually applied from the talus to the calcaneus through the fractu re after reduction of the posterior facet, Nine cases (8.5%) developed post operative infection, four cases (3.8%) had superficial wound infection, fou r cases (3.8%) had pin tract infection and one case (0.9%) had osteomylitis . Our follow-up at an average of 29 months (range, 12 to 84 months) showed that the American Orthopedic Foot and Ankle Society, Ankle-Hindfoot Score f or the all group was 77.6 (range, 31-91), Forty-one fractures (38.8%) were graded excellent, 39 fractures (36.7%) good, 14 fractures (13.2%) fair, and 12 fractures (11.3%) were failures. Although radiological degenerative cha nges in the subtalar joint were seen in 41 cases (38.7%), only six cases (5 .6%) required subsequent subtalar fusion, The authors conclude that the ope rative method used in the current study which followed the principle of min imal soft tissue damage and minimal internal fixation may be a good option for management of calcaneus fractures.