Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach

Introduction: The wound complication rate for open reduction and internal fixation of calcaneus fractures through the extensile approach is 30%. Due to this high rate of wound complications, many surgeons prefer conservative management. If post-traumatic arthritis develops, the clinical results of a subtalar fusion are better if the posterior facet is reduced and the shape of the calcaneus restored. The sinus tarsi approach utilises a much smaller incision and indirect reduction techniques limiting the need for a large incision while still providing good exposure of the posterior facet for anatomic reduction. The purpose of this study is to present the technique for open reduction and internal fixation through a sinus tarsi approach, to assess the adequacy of reduction and the complication rate. Methods: A retrospective chart and X-ray review was performed of all patients who had an open reduction and internal fixation of the calcaneus performed since 2013. We report on the interim results of the adequacy of reduction and maintenance thereof and the incidence of wound complications. Follow-up was for a minimum of 6 weeks. Results: Twelve procedures were performed in this time. The Bohler’s angle improved from a median of 12° pre-operatively to 28.5° (p=0.002) post-operatively. The angle of Gissane improved from a median of 125° to 110° (p=0.0001). Two patients had minor wound complications, both of which were managed without surgery, using dressings for 10 to 12 days. Conclusion: Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach allows adequate reduction with a low incidence of wound complications.