Quality of Reduction of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Versus Extensile Lateral Approach

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 tuberosityCT reduction grading includedExcellent (E)no gap, no step, and no angulation; Good (G)15 angulation. RESULTS:77 patients with 83 fractures were included. Average age was 42 (range18 – 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