Journal of Musculoskeletal Trauma

Original Articles

Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach: Hong Ki Park, Jae Yoon Ko, Seung Kwan Lee, Jong Min Baik; J Korean Fract Soc 2019;32(3):135-142. Published online July 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.3.135

PURPOSE
As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA.
MATERIALS AND METHODS
Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments.
RESULTS
No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group.
CONCLUSION
The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

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Clinical and Radiological Outcomes of ‘Blocking Kirschner Wire Technique’ in Displaced Intra-Articular Calcaneal Fractures via the Extended Sinus Tarsi Approach
Jeong-Kil Lee, Chan Kang, Sang-Bum Kim, Gi-Soo Lee, Jung-Mo Hwang, Byung-Kuk An
Journal of the Korean Orthopaedic Association.2021; 56(3): 224. CrossRef

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A Comparison of Extensile Lateral Approach and Sinus Tarsi Approach for the Sanders Type II Calcaneal Fracture: Jeong Seok Moon, Woo Chun Lee; J Korean Fract Soc 2009;22(1):13-18. Published online January 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.1.13

Abstract PDF

PURPOSE
To compare the clinical results between the extensile lateral approach and sinus tarsi approach in the open reduction of the Sanders type II calcaneal fracture.
MATERIALS AND METHODS
From July 2002 to Februry 2007, thirty two patients having thirty three calcaneal fractures of Sanders type II were managed with open reduction and internal fixation using the extensile lateral approach or sinus tarsi approach. The mean age of 19 patients using extensile lateral approach was 43.3 years. The mean age of 13 patients using sinus tarsi approach was 46.3 years. Clinical outcome, radiographic parameters, and postoperative complications were compared between both groups.
RESULTS
There was no difference between two groups associated with patients demographs. The mean AOFAS score and VAS between both groups were not different (p=0.716, p=0.774). The mean Bohler's angle and Gissane's angle between both groups were not different (p=0.343, p=0.357). Two cases of sural nerve injury, one malunion, and one deep infection were occurred in the group of extensile lateral approach. However, patients using sinus tarsi approach had no postoperative complications.
CONCLUSION
The clinical results of sinus tarsi approach may be comparable with those of extensile lateral approach, with the advantages of reduced risk of postoperative complications.

Citations

Citations to this article as recorded by

The Extensile Lateral Approach to the Calcaneus
Rohan Bhimani, Kush C. Shah, Rishin J. Kadakia
Techniques in Foot & Ankle Surgery.2025;[Epub] CrossRef
Extensile lateral versus sinus tarsi approach for calcaneal fractures
Chuangang Peng, Baoming Yuan, Wenlai Guo, Na Li, Heng Tian
Medicine.2021; 100(31): e26717. CrossRef
Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis
Andrea Seat, Christopher Seat
The Journal of Foot and Ankle Surgery.2020; 59(2): 356. CrossRef
Surgical Treatment of Calcaneal Fractures of Sanders Type II and III by A Minimally Invasive Technique with 6.5 mm Cancellous Screw
Yong Seung Oh, Kyung Ho Lee, Jung Ho Kim, Myoung Jin Lee
Journal of Korean Foot and Ankle Society.2019; 23(3): 116. CrossRef
A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures
Tomasz L. Nosewicz, Siem A. Dingemans, Manouk Backes, Jan S.K. Luitse, J. Carel Goslings, Tim Schepers
Foot and Ankle Surgery.2019; 25(5): 580. CrossRef
Meta‐analysis of two surgical approaches for calcaneal fractures: sinus tarsi versus extensile lateral approach
Fei Zhang, Hongtao Tian, Shilun Li, Bo Liu, Tianhua Dong, Yanbin Zhu, Yingze Zhang
ANZ Journal of Surgery.2017; 87(3): 126. CrossRef
Usefulness of Treatment with 6.5 mm Cancellous Screw and Steinmann Pin Fixation for Calcaneal Joint Depression Fracture
Gi-Soo Lee, Chan Kang, Deuk-Soo Hwang, Chang-Kyun Noh, Gi-Young Lee
Journal of Korean Foot and Ankle Society.2015; 19(1): 11. CrossRef
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
Shengli Xia, Yaogang Lu, Huizhong Wang, Zuming Wu, Ziping Wang
International Journal of Surgery.2014; 12(5): 475. CrossRef
Intra-articular Calcaneal Fractures Treated with Open Reduction and Internal Fixation -A Comparative Study between Groups with and without Bone Graft-
Hong Moon Sohn, Sang Ho Ha, Jun Young Lee, Sung Hwan Jo, Hoon Yang
Journal of the Korean Fracture Society.2010; 23(2): 180. CrossRef

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Operative Treatment of Intraarticular Calcaneus Fractures with extensile lateral approach: Dong Kyu Shin, Yong Woon Kim; J Korean Soc Fract 2001;14(3):440-449. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.440

Abstract PDF: PURPOSE
Through the analysing intraarticular calcaneal fractures operated with extensile lateal approach and lateral plate fixation we tried to find the factors related to the result and to prove the usefulness of this treatment method. MATERIAL AND METHOD: We reviewed 50 intraarticular calcaneal fractures which were treated with this method between July 1995 and December 1998. We analysed the relationship between the fracture type and the accuracy of posterior facet reduction and between the accuracy of reduction and the clinical result. We also analysed the complication rate.
RESULT
We gained anatomical reduction in 64% among all cases. There was significant relationship statistically between the Sanders fracture type and accuracy of reduction(p=0.001). There were also significant relationship statistically between the Sanders fractrure type and the clinical result(p=0.045) and between the accuracy of reduction and clinical result(p=0.001). It was also possible to regain the calcaneal height, width and Bohler angle through this treatment method. There was only one wound complication which was skin necrosis and was treated with dressing and finally skin graft.
CONCLUSION
Sanders classification was very useful and reasonable for this kind of fracture. The accuracy of reduction of posterior facet was very important to clinical result. This treatment method for the calcaneal fracture was useful in the term of regain of anatomical components of calcaneus such as posterior facet congruency, calcaenal height, width and Bohler angle with acceptable rate of serious complication.

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Result of Surgical Treatment of Calcaneal Fractures Using Extensile Lateral Approach: Sung Do Cho, Yong Sun Cho, Bum Soo Kim, Tae Woo Park, Gi Bong Kim, Key Yong Kim; J Korean Soc Fract 1999;12(2):320-327. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.320

Abstract PDF

Thirty-eight calcaneal fractures were treated with open reduction and internal fixation using extensile lateral approach from Jun. 1993 to Dec. 1996 and were followed more than a year. According to the Essex-Lopresti classification, there were 28 cases of joint depression type and 10 cases of tongue type. According to the Sanders classification, there were 20 cases of type II, 13 cases of type III and 5 cases of type IV. The purpose of this study is to analyze the results of surgical treatment of calcaneal fractures using extensile lateral approach and its complications. The results were as follows; 1. B.. ohler angle was improved from -2.4degrees to 20.5degrees and Gissane angle was improved from 114.5degrees to 120.4degreesafter the operation. The height of the calcaneus was improved from 75% to 95% and the width of the calcaneus was reduced from 119% to 106% of contralateral side. 2. yThe postoperative reduction status of the articular surface was analyzed by computed tomography(CT) in 18 patients and was found to be less than 2 mm of step-off in 10 cases, between 2 and 5 mm in 7 cases and more than 5 mm in 1 case. 3. Based on the assessment criteria of Salama et al., the functional results were excellent in 10 cases, good in 14 cases, fair in 10 cases, and poor in 4 cases. Unsatisfactory results were correlated with severity of articular comminution and failure to obtain accurate reduction of the articular surface. 4. Fourteen cases (36.8%), developed postoperative complications such as heel pain, causalgia and numbness, subtalar arthritis, marginal necrosis of wound, lateral subfibular impingement and heel bulging. In conclusion, Because of high incidence of postoperative complications, careful and meticulous exposure technique in doing extensile lateral approach are necessary for a satisfactory outcomes.

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Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients
Hong-Moon Sohn, Sang-Ho Ha, Sang-Hong Lee, Jun-Young Lee, Jeong-Ho Kim, Sang-Jun Lee
Journal of the Korean Fracture Society.2008; 21(3): 195. CrossRef

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