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Quality of Reduction of Displaced Intra-Articular Calcaneal Fractures Using a Sinus Tarsi versus Extensile Lateral Approach.

Abstract：

OBJECTIVE:To evaluate the difference in quality of fracture reduction between the sinus tarsi approach (STA) and extensile lateral approach (ELA) using postoperative CT scans in displaced intra-articular calcaneal fractures (DIACFs). DESIGN:Retrospective SETTING:: Level 1 and Level 2 academic centers. PATIENTS:Consecutive patients undergoing operative fixation of DIACFs with post-operative CT scans and standard radiographs. METHODS:Patients were identified based on CPT code and chart review. All operative calcaneal fractures treated between 2012-2018 by fellowship trained orthopaedic trauma surgeons were evaluated. Those with both post-operative CT scans and radiographs were included. Exclusion criteria included extra-articular fractures, malunions, percutaneous fixation, ORIF and primary fusion, and those patients without a postoperative CT scan. The Sanders classification was used. Cases were divided into 2 groups based on ELA vs. STA. Bohler's angle and Gissane's angle were evaluated on plain radiographs. CT reduction quality grading included articular step off/gap within the posterior facet, and varus angulation of the tuberosity: CT reduction grading included: Excellent (E): no gap, no step, and no angulation; Good (G): <1mm step, <5mm gap and/or <5 of angulation, Fair (F): 1-3mm step, 5-10mm gap, and/or 5-15 angulation; and Poor (P): >3mm step, >10mm gap, and/or >15 angulation. RESULTS:77 patients with 83 fractures were included. Average age was 42 (range: 18 - 74), with 57 males. Four fractures were open. There were 37 Sanders II and 46 Sanders III fractures. 36 fractures were fixed using the STA while 47 used the ELA. Average days to surgery were 5 for STA, 14 for ELA (p<0.001). A normal Bohler's angle was achieved more often with the ELA (91.5%) than with STA (77.8%) (p<0.001). There was no difference by approach for Gissane's angle (p=0.5). ELA had better overall reduction quality (p=0.02). For Sanders II, there was no difference in reduction quality with STA vs ELA (p = 0.51). For Sanders III, ELA trended towards better reduction quality (p = 0.06). CONCLUSION:The extensile lateral approach (ELA) had a better overall reduction of Bohler's angle on plain radiographs and of the posterior facet and tuberosity on postop CT scans. For Sanders type II DIACFs there was no difference between STA and ELA. Importantly for Sanders III DIACFs, ELA trended towards better reduction quality. In addition to fracture reduction, surgeon learning curve, early wound complications and long-term outcomes must be considered in future studies comparing the ELA and STA. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

journal_name

J Orthop Trauma

journal_title

Journal of orthopaedic trauma

authors

Busel G,Mir HR,Merimee S,Patel R,Atassi O,De La Fuente G,Donohue D,Maxson B,Infante A,Shah A,Watson D,Downes K,Sanders RW

doi

10.1097/BOT.0000000000001971

subject

Has Abstract

pub_date

2020-09-18 00:00:00

eissn

0890-5339

issn

1531-2291

pub_type

杂志文章

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Quality of Reduction of Displaced Intra-Articular Calcaneal Fractures Using a Sinus Tarsi versus Extensile Lateral Approach.