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Comparison of Sinus Tarsi and Extensile Lateral Approach in Intra-articular Calcaneus Fractures

Year 2022, Volume: 32 Issue: 5, 534 - 539, 29.10.2022

Necip Güven Sezai Özkan Fatih Güzel Tülin Türközü Şehmuz Kaya Abbas Tokyay

https://doi.org/10.54005/geneltip.1142591

Abstract

Objective: In this study, we aimed to compare the clinical and radiological results of the extensile lateral (EL) approach and sinus tarsi (ST) approach in calcaneal fracture surgery.
Materyal-Metod: A total of 40 patients with Sanders II-III calcaneal fractures, including 22 patients in the EL group and 18 patients in the ST group, were included in this retrospective study. In the radiological evaluation, changes in the calcaneus Bohler and Gissane angle, length, width, and height were measured during the preoperative and postoperative period. Clinically, American Orthopedic Foot and Ankle Society (AOFAS) and the visual analog scale (VAS) were evaluated. In addition, postoperative complications were also evaluated.
Results: In terms of demographic data, the results of both groups were similar. Both the length of hospital stay and the time to surgery were shorter in the ST group (p=0.019, p=0.02, respectively). There was no significant difference between the groups regarding radiological, clinical AOFAS and VAS scores. 13.6% superficial infection was seen in the EL group, and no wound problems were encountered in the ST group (p=0.102). The rate of sural nerve injury was 36.4% in the EL group and 5.6% in the ST group (p =0.003).
Conclusion: Both approaches clinical and radiological outcomes were similar. However, the advantages of the ST approach were shorter hospital stays, lower rate wound infections, and sural nerve injury problems.

Keywords

Calcaneus fracture extensile lateral sinus tarsi minimally invasive

References

  • 1. Buzzi R, Sermi N, Soviero F, Bianco S, Campanacci DA. Displaced intra-articular fractures of the calcaneus: ORIF through an extended lateral approach. Injury. 2019 Jul;50 Suppl 2:S2-S7.
  • 2. Khazen G, Rassi CK. Sinus Tarsi Approach for Calcaneal Fractures: The New Gold Standard? Foot Ankle Clin. 2020 Dec;25(4):667-681.
  • 3. Sharr PJ, Mangupli MM, Winson IG, Buckley RE. Current management options for displaced intra-articular calcaneal fractures: Non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review. Foot Ankle Surg. 2016 Mar;22(1):1-8.
  • 4 Griffin D, Parsons N, Shaw E, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ. 2014 Jul 24;349: g4483.
  • 5. Dickenson EJ, Parsons N, Griffin DR. Open reduction and internal fixation versus nonoperative treatment for closed, displaced, intra-articular fractures of the calcaneus: long-term follow-up from the HeFT randomized controlled trial. Bone Joint J. 2021 Jun;103-B(6):1040-1046.
  • 6. Zhou HC, Yu T, Ren HY, et al. Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures. Orthop Surg. 2017 Feb;9(1):77-85.
  • 7. Schepers T. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systemic review. Int Orthop. 2011; 35:697-703.
  • 8. Yeo JH, Cho HJ, Lee KB. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach. BMC Musculoskelet Disord. 2015 Mar 19; 16:63.
  • 9. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2000; 82:225-50.
  • 10. Maskill JD, Bohay DR, Anderson JG. Calcaneus fractures: a review article. Foot Ankle Clin, 2005, 10: 463–489
  • 11. Seat A, Seat C. Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis. J Foot Ankle Surg. 2020 Mar-Apr;59(2):356-366.
  • 12. Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int, 2013, 34: 773–780.
  • 13. Ma C, Zhao J, Zhang Y, et al. Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures. Ann Transl Med. 2021 Apr;9(8):695.
  • 14. Xia S, Lu Y, Wang H, Wu Z, Wang Z. Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures - a randomized controlled trial. Int J Surg. 2014;12(5):475-80.
  • 15. Basile A, Albo F, Via AG. Comparison Between Sinus Tarsi Approach and Extensile Lateral Approach for Treatment of Closed Displaced Intra-Articular Calcaneal Fractures: A Multicenter Prospective Study. J Foot Ankle Surg. 2016 May-Jun;55(3):513-21.
  • 16. Hildebrand KA, Buckley RE, Mohtadi NG, Faris P. Functional outcome measures after displaced intra-articular calcaneal fractures. J Bone Joint Surg Br. 1996 Jan;78(1):119-23.
  • 17. Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int. 2013 Jun;34(6):773-80.
  • 18. Lin J, Xie C, Chen K, et al. Comparison of sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fractures Sanders type IV. Int Orthop. 2019 Sep;43(9):2141-2149.
  • 19. Weber M, Lehmann O, Sagesser D, Krause F. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2008; 90:1608-16
  • 20. Park JH, Chun DI, Park KR, et al. Can sural nerve injury be avoided in the sinus tarsi approach for calcaneal fracture?: A cadaveric study. Medicine (Baltimore). 2019 Oct;98(42): e17611.
  • 21. Csizy M, Buckley R, Tough S, et al. Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion. J Orthop Trauma. 2003 Feb;17(2):106-12.
  • 22. Harvey EJ, Grujic L, Early JS, Benirschke SK, Sangeorzan BJ. Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int. 2001; 11:868-73.
  • 23. Schindler C, Schirm A, Zdravkovic V, Potocnik P, Jost B, Toepfer A. Outcomes of intra-articular calcaneal fractures: surgical treatment of 114 consecutive cases at a maximum care trauma center. BMC Musculoskelet Disord. 2021 Mar 1;22(1):234.
  • 24. Shuler FD, Conti SF, Gruen GS, Abidi NA. Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures: does correction of Bohler's angle alter outcomes? Orthop Clin North Am. 2001 Jan;32(1):187-92, x.
  • 25. Kwon JY, Guss D, Lin DE, et al. Effect of Delay to Definitive Surgical Fixation on Wound Complications in the Treatment of Closed, Intra-articular Calcaneus Fractures. Foot Ankle Int 2015; 36:508-17.

Eklem İçi Kalkaneus Kırıklarında Sinus Tarsi ve Ekstensil Lateral Yaklaşımın Karşılaştırılması

Year 2022, Volume: 32 Issue: 5, 534 - 539, 29.10.2022

Necip Güven Sezai Özkan Fatih Güzel Tülin Türközü Şehmuz Kaya Abbas Tokyay

https://doi.org/10.54005/geneltip.1142591

Abstract

Amaç: Bu çalışmada kalkaneus kırığı cerrahisinde ekstansil lateral (EL) yaklaşım ile sinüs tarsi (ST) yaklaşımının klinik ve radyolojik sonuçlarını karşılaştırmayı amaçladık.
Gereç ve yöntem: Bu retrospektif çalışmaya, EL grupta 22 hasta ve sinüs tarsi grubunda 18 hasta olmak üzere Sanders II-III kalkaneus kırığı olan toplam 40 hasta dahil edildi. Radyolojik değerlendirmede, preoperative ve postoperative dönemde Bohler ve Gissane açısı, kalkaneusun uzunluğu, genişliği ve yüksekliğindeki değişiklikler ölçüldü. Klinik olarak ise Amerikan Ortopedik Ayak ve Ayak Bileği Derneği (AOFAS) ve görsel analog skalası (VAS) değerlendirildi. Ayrıca postoperative komplikasyonlar da değerlendirildi.
Bulgular: Demografik veriler açısından her iki grubun sonuçları benzerdi. ST grubundaki hastaların lateral ekstensil grubuna göre ameliyata alınma ve hastane kalış süresi açısından istatistiksel olarak anlamlı bir şekilde daha kısaydı ( p=0.019, p=0.02, sırasıyla). Gruplar arasında radyolojik, klinik AOFAS ve VAS skorları açısından anlamlı fark bulunmadı. Ekstensile lateral grubunda %13,6 yüzeyel enfeksiyon görüldü ve sinüs tarsi grubunda herhangi bir yara sorununa rastlanmadı (p=0,102). Sural sinir yaralanması extensil lateral grupta 36.4% oranında, sinüs tarsi grubunda ise 5.6% oranında görüldü (p=0.003).
Sonuç: Her iki yaklaşımın klinik ve radyolojik sonuçları benzerdi. Ancak hastanede kısa yatış süresi, yara yeri enfeksiyon problemlerinin ve sural sinir yaralanmasının az olması ST yaklaşımının avantajıydı.

Keywords

Kalkaneus kırığı ekstensil lateral sinus tarsi

References

  • 1. Buzzi R, Sermi N, Soviero F, Bianco S, Campanacci DA. Displaced intra-articular fractures of the calcaneus: ORIF through an extended lateral approach. Injury. 2019 Jul;50 Suppl 2:S2-S7.
  • 2. Khazen G, Rassi CK. Sinus Tarsi Approach for Calcaneal Fractures: The New Gold Standard? Foot Ankle Clin. 2020 Dec;25(4):667-681.
  • 3. Sharr PJ, Mangupli MM, Winson IG, Buckley RE. Current management options for displaced intra-articular calcaneal fractures: Non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review. Foot Ankle Surg. 2016 Mar;22(1):1-8.
  • 4 Griffin D, Parsons N, Shaw E, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ. 2014 Jul 24;349: g4483.
  • 5. Dickenson EJ, Parsons N, Griffin DR. Open reduction and internal fixation versus nonoperative treatment for closed, displaced, intra-articular fractures of the calcaneus: long-term follow-up from the HeFT randomized controlled trial. Bone Joint J. 2021 Jun;103-B(6):1040-1046.
  • 6. Zhou HC, Yu T, Ren HY, et al. Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures. Orthop Surg. 2017 Feb;9(1):77-85.
  • 7. Schepers T. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systemic review. Int Orthop. 2011; 35:697-703.
  • 8. Yeo JH, Cho HJ, Lee KB. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach. BMC Musculoskelet Disord. 2015 Mar 19; 16:63.
  • 9. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2000; 82:225-50.
  • 10. Maskill JD, Bohay DR, Anderson JG. Calcaneus fractures: a review article. Foot Ankle Clin, 2005, 10: 463–489
  • 11. Seat A, Seat C. Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis. J Foot Ankle Surg. 2020 Mar-Apr;59(2):356-366.
  • 12. Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int, 2013, 34: 773–780.
  • 13. Ma C, Zhao J, Zhang Y, et al. Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures. Ann Transl Med. 2021 Apr;9(8):695.
  • 14. Xia S, Lu Y, Wang H, Wu Z, Wang Z. Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures - a randomized controlled trial. Int J Surg. 2014;12(5):475-80.
  • 15. Basile A, Albo F, Via AG. Comparison Between Sinus Tarsi Approach and Extensile Lateral Approach for Treatment of Closed Displaced Intra-Articular Calcaneal Fractures: A Multicenter Prospective Study. J Foot Ankle Surg. 2016 May-Jun;55(3):513-21.
  • 16. Hildebrand KA, Buckley RE, Mohtadi NG, Faris P. Functional outcome measures after displaced intra-articular calcaneal fractures. J Bone Joint Surg Br. 1996 Jan;78(1):119-23.
  • 17. Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int. 2013 Jun;34(6):773-80.
  • 18. Lin J, Xie C, Chen K, et al. Comparison of sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fractures Sanders type IV. Int Orthop. 2019 Sep;43(9):2141-2149.
  • 19. Weber M, Lehmann O, Sagesser D, Krause F. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2008; 90:1608-16
  • 20. Park JH, Chun DI, Park KR, et al. Can sural nerve injury be avoided in the sinus tarsi approach for calcaneal fracture?: A cadaveric study. Medicine (Baltimore). 2019 Oct;98(42): e17611.
  • 21. Csizy M, Buckley R, Tough S, et al. Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion. J Orthop Trauma. 2003 Feb;17(2):106-12.
  • 22. Harvey EJ, Grujic L, Early JS, Benirschke SK, Sangeorzan BJ. Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int. 2001; 11:868-73.
  • 23. Schindler C, Schirm A, Zdravkovic V, Potocnik P, Jost B, Toepfer A. Outcomes of intra-articular calcaneal fractures: surgical treatment of 114 consecutive cases at a maximum care trauma center. BMC Musculoskelet Disord. 2021 Mar 1;22(1):234.
  • 24. Shuler FD, Conti SF, Gruen GS, Abidi NA. Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures: does correction of Bohler's angle alter outcomes? Orthop Clin North Am. 2001 Jan;32(1):187-92, x.
  • 25. Kwon JY, Guss D, Lin DE, et al. Effect of Delay to Definitive Surgical Fixation on Wound Complications in the Treatment of Closed, Intra-articular Calcaneus Fractures. Foot Ankle Int 2015; 36:508-17.
There are 25 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Article
Authors

Necip Güven 0000-0002-0363-1524

Sezai Özkan 0000-0003-4444-6939

Fatih Güzel 0000-0002-2622-8199

Tülin Türközü 0000-0002-0966-9080

Şehmuz Kaya 0000-0002-9636-5260

Abbas Tokyay 0000-0002-3914-1906

Early Pub Date October 24, 2022
Publication Date October 29, 2022
Submission Date July 8, 2022
Published in Issue Year 2022 Volume: 32 Issue: 5

Cite

Vancouver Güven N, Özkan S, Güzel F, Türközü T, Kaya Ş, Tokyay A. Comparison of Sinus Tarsi and Extensile Lateral Approach in Intra-articular Calcaneus Fractures. Genel Tıp Derg. 2022;32(5):534-9.

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