Management of displaced intra-articular calcaneal fractures using the limited open sinus tarsi approach and fixation by screws only technique.

Purpose: Evaluation of management of the displaced intra-articular calcaneal fractures (DIACF) Sanders types II and III by using minimally invasive sinus tarsi approach and fixation by screws only technique.

Methods: Open reduction using the limited lateral approach and internal fixation using screws only was studied in 33 patients with unilateral isolated simple DIACF with a mean age of 35 years (15 type II patients and 18 type III patients). All patients were evaluated both clinically and radiologically.

Results: With a mean follow-up period of 28.8 months (range 12-53 months), no cases of failure of reduction or displacement of hardware were detected. The mean AOFAS was 91.73 points while the mean MFS was 95.09 points. Twenty-eight patients were able to resume their pre-injury level of work while the remaining five refrained to sedentary jobs. The mean pre-operative Bohlers' angle was 2.8° (range from -38º to 24º) while postoperatively it was 19.4° (range 5º to 49º). There was no statistically significant difference when comparing the results (AOFAS p-value 1.00, MFS p-value 0.81) between Sanders' type II and III fractures. One patient had postoperative superficial wound infection. Seven patients complained of prominent screw heads. Complex regional pain syndrome occurred in seven patients and was treated successfully at six months duration.

Conclusion: The limited open sinus tarsi approach can be used successfully to treat displaced Sanders type II and III fractures. It allows for adequate visualization and reduction. Fixation by screws only is also sufficient. It also clearly avoids the major wound complication problems.