Combined extensile medial and sinus tarsi approaches for intra-articular calcaneus fractures: a case series.

BACKGROUND

This study aimed to evaluate the clinical efficacy of combining the extensile medial approach with the sinus tarsi approach for treating intra-articular calcaneus fractures.

METHODS

A retrospective analysis was conducted on 11 patients who underwent combined extensile medial and sinus tarsi approaches between January 2022 and July 2023. Preoperative and postoperative radiographic measurements of the calcaneus, including length, width, height, varus angle, Böhler’s angle, and Gissane’s angle were obtained. Functional outcomes were assessed at the final follow-up using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score.

RESULTS

All operations succeeded, and the anatomical structure and articular surface of the calcaneus were recovered, with mean operative time 171.5 ± 29.0 min, average bleeding 97.7 ± 47.1 mL. Imaging comparisons (postoperative and final follow-up vs. preoperative) demonstrated that significant improvements were observed in calcaneal length (p = 0.042), height (p = 0.0005), width (p < 0.001), and Böhler’s angle (p = 0.001) at final follow-up compared to preoperative values. No statistically significant difference was noted in Gissane’s angle (p = 0.113), while the varus angle showed significant correction (p < 0.001). Moreover, all imaging parameters were stable from the postoperative period to the final follow-up (p > 0.05). The mean AOFAS score at one year postoperatively was 91.3 ± 7.6, indicating excellent functional recovery.

CONCLUSION

This study demonstrates that the extensile medial approach, when strategically combined with the sinus tarsi approach, provides superior direct visualization of the medial wall and subtalar joint articular surface. The technique effectively restores calcaneal morphology and achieves high functional scores, particularly in Sander’s type III/IV fractures. These findings support its consideration as an advanced option for managing challenging calcaneal fracture patterns.