Functional Outcomes in Calcaneal Fracture Treated with Calcaneal Perimeter Plating
DOI:
https://doi.org/10.51253/pafmj.v75i2.12951Keywords:
Calcaneal Fractures, Intra Articular, Perimeter Plating, Wound ComplicationsAbstract
Objective: to compare the Lateral Extensile Approach with the less invasive Sinus Tarsi Approach regarding functional outcomes and wound complications.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Dec 2023 to Nov 2024.
Methodology: Forty-four patients with a closed, isolated calcaneal fracture with optimal skin condition were sequentially enrolled into two groups. All patients underwent open reduction internal fixation with the same calcaneal perimeter plate using the Lateral Extensile Approach in Group-A patients and the Sinus Tarsi Approach in Group-B patients. Clinical outcome was assessed by The American Orthopedic Foot and Ankle Society Score at 6 months. The adequacy of reduction was evaluated by Calcaneal Width, Bohler’s, and Gissane’s angle via post-operative radiograph. Patients were followed up at 2 weeks, 3, and 6 months for documentation of soft tissue complications.
Results: Patients in both Groups demonstrated satisfactory reduction of fractures with no significant difference in Calcaneal Width, Bohler’s or Gissane’s angle. Similarly, no substantial variance was observed in the American Orthopedic Foot and Ankle Society score at 6-months follow-up. The lateral extensile Group had two superficial and one deep flap-related complication, while none was noted in the sinus tarsi Group.
Conclusion: The current study suggests that the Sinus Tarsi Approach should be the preferred technique for treating DIACFs, as it produces similar results and fewer complications.
Downloads
References
Schepers T, Ginai AZ, Van Lieshout EM, Patka P. Demographics of extra-articular calcaneal fractures: including a review of the literature on treatment and outcome. Arch Orthop Trauma Surg 2008; 128(10): 1099-1106.
https://doi.org/10.1007/s00402-007-0517-2
Ahluwalia R, Lewis TL, Musbahi O, Reichert I. Minimally Invasive Surgery vs Nonoperative Treatment for Displaced Intraarticular Calcaneal Fracture: A Prospective Propensity Score Matched Cohort Study With 2-Year Follow-up. Foot Ankle Int 2024; 45(5): 456-466.
https://doi.org/10.1177/10711007241230550
Schleunes S, Lobos E, Saltrick K. Current Management of Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2024; 41(3): 473-490.
https://doi.org/10.1016/j.cpm.2024.01.006
Bába V, Kopp L. Calcaneal fractures - current trends and pitfalls. Rozhl Chir. 2021; 100(8): 369-375.
https://doi.org/10.33699/pis.2021.100.8.369-375
Walsh TP, Vasudeva V, Sampang K, Platt SR. Psychological dysfunction associated with calcaneal fractures. Injury 2021; 52(8): 2475-2478.
https://doi.org/10.1016/j.injury.2021.05.013
Italiano J, Bitterman AD. Diagnosis and Management of Calcaneal Stress Fractures. Radiol Technol 2021; 93(2): 177-194.
Peng C, Yuan B, Guo W, Li N, Tian H. Extensile lateral versus sinus tarsi approach for calcaneal fractures: A meta-analysis. Medicine 2021; 100(31): e26717.
https://doi.org/10.1097/md.0000000000026717
Zhuang L, Wang L, Xu D, Wang Z, Zheng J. Same wound complications between extensile lateral approach and sinus tarsi approach for displaced intra-articular calcaneal fractures with the same locking compression plates fixation: a 9-year follow-up of 384 patients. Eur J Trauma Emerg Surg 2021; 47(4): 1211-1219.
https://doi.org/10.1007/s00068-019-01221-2
Yu T, Xiong Y, Kang A, Zhou H, He W, Zhu H, et al. Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses. J Orthop Surg 2020; 28(2): 2309499020915282.
https://doi.org/10.1177/2309499020915282
Rammelt S, Swords MP. Calcaneal Fractures-Which Approach for Which Fracture? Orthop Clin North Am 2021; 52(4): 433-450.
https://doi.org/10.1016/j.ocl.2021.05.012
Khazen G, Rassi CK. Sinus Tarsi Approach for Calcaneal Fractures: The New Gold Standard? Foot Ankle Clin 2020; 25(4): 667-681. https://doi.org/10.1016/j.fcl.2020.08.003
Prather J, Wilson J, Abyar E, Young S, McGwin G, Crocker CC, et al. Exposure of the Calcaneus in the Sinus Tarsi Approach Versus the Lateral Extensile Approach: A Cadaveric Study. Foot Ankle Spec 2022: 19386400221114488.
https://doi.org/10.1177/19386400221114488
Khurana A, Dhillon MS, Prabhakar S, John R. Outcome evaluation of minimally invasive surgery versus extensile lateral approach in management of displaced intra-articular calcaneal fractures: A randomised control trial. Foot 2017; 31: 23-30.
https://doi.org/10.1016/j.foot.2017.01.008
Attenasio A, Heiman E, Hong IS, Bhalla AP, Jankowski JM, Yoon RS, et al. Postoperative wound complications in extensile lateral approach versus sinus tarsi approach for calcaneal fractures: Are we improving? Updated meta-analysis of recent literature. Injury 2024; 55(6): 111560.
https://doi.org/10.1016/j.injury.2024.111560
Huang PJ, Huang HT, Chen TB, Chen JC, Lin YK, Cheng YM, et al. Open reduction and internal fixation of displaced intra-articular fractures of the calcaneus. J Trauma 2002; 52(5): 946-950.
https://doi.org/10.1097/00005373-200205000-00021
Pombo B, Ferreira AC, Costa L. Bohler Angle and the Crucial Angle of Gissane in Paediatric Population. Clin Med Insights Arthritis Musculoskelet Disord 2019; 12: 1179544119835227.
https://doi.org/10.1177/1179544119835227
Wang Y, Jiang J, Li J, Huang W. A study on the relationship between postoperative prognosis of calcaneal fracture and the final Bohler angle, calcaneal width respectively. Asian J Surg 2024; 246.
https://doi.org/10.1016/j.asjsur.2024.08.246
Xia S, Lu Y, Wang H, Wu Z, Wang Z. 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. Int J Surg 2014; 12(5): 475-480.
https://doi.org/10.1016/j.ijsu.2014.03.001
Zhou HC, Yu T, Ren HY, Li B, Chen K, Zhao YG, et al. Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures. Orthop Surg 2017; 9(1): 77-85.
https://doi.org/10.1111/os.12310
Sharma GK, Dhillon MS, Dhatt SS. The influence of foot and ankle injury patterns and treatment delays on outcomes in a tertiary hospital; a one-year prospective observation. Foot 2016; 26: 48-52.
https://doi.org/10.1016/j.foot.2015.12.001
Cursaru A, Crețu B, Șerban B, Iordache S, Popa M, Smarandache CG, et al. Minimally invasive treatment and internal fixation vs. extended lateral approach in calcaneus fractures of thalamic interest. Exp Ther Med 2022; 23(3): 196.
https://doi.org/10.3892/etm.2022.11119
Veltman ES, Doornberg JN, Stufkens SA, Luitse JS, van den Bekerom MP. Long-term outcomes of 1,730 calcaneal fractures: systematic review of the literature. J Foot Ankle Surg 2013; 52(4): 486-490.
https://doi.org/10.1053/j.jfas.2013.04.002
Andermahr J, Helling HJ, Rehm KE, Koebke Z. The vascularization of the os calcaneum and the clinical consequences. Clin Orthop Relat Res 1999(363): 212-218.
Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int 2013; 34(6): 773-780.
https://doi.org/10.1177/1071100713477607
Jin C, Weng D, Yang W, He W, Liang W, Qian Y. Minimally invasive percutaneous osteosynthesis versus ORIF for Sanders type II and III calcaneal fractures: a prospective, randomized intervention trial. J Orthop Surg Res 2017; 12(1): 10.
Downloads
Published
License
Copyright (c) 2025 Asad Moiz Hussain, Muhammad Suhail Amin, Bilal Ahmad Qureshi, Najeeb Ullah Tareen

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.