Fixation of displaced intra-articular calcaneus fractures is safe using either sinus tarsi or extensile lateral approach

The thin soft tissue envelope and tenuous blood supply to the lateral heel create challenges in treating displaced intra-articular calcaneus fractures (DIACF) [1]. The extensile lateral approach (ELA) has been preferred for plate fixation in DIACF due to its broad access for visualization and reduction of the calcaneal body, tuberosity and articular surface [2], [3], [4]. High rates of wound complications, including apical wound necrosis, dehiscence, and deep infection have marred surgeon experience with the ELA though these outcomes improve with experience [5], [6], [7]. Recently, the less invasive sinus tarsi approach (STA) has gained popularity due to the reduction in soft tissue insult with reported similar articular reduction quality and functional outcomes compared to the ELA [8], [9], [10], [11], [12].

Existing literature describing outcomes using STA versus ELA in DIACF are heterogeneous. Small case-control and prospective comparisons of the two approaches have observed higher wound complication rates with the ELA, though some failed to reach statistical significance [13], [14], [15], [16], [17]. Meta-analyses have highlighted shorter time to surgery, shorter procedure length, and fewer wound complications with the STA without clear differences in radiographic or functional outcomes [18], [19], [20]. Recently, reduction quality in more severe fracture patterns has favored the ELA [21]. Given the lack of strong consensus, the aim of this study was to assess for associations between surgical approach, STA or ELA, and clinical and functional outcomes following DIACF. Secondarily, we sought to identify risk factors for secondary, unplanned procedures in these injuries.

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