Sinus Tarsi Approach Combined with Posterolateral Approach versus Extended Lateral Approach for Calcaneal Fractures: A Retrospective Cohort Study
This retrospective cohort study demonstrates that while both the combined sinus tarsi and posterolateral approach (STA-PLA) and the extended lateral approach (ELA) achieve comparable radiographic and functional outcomes for Sanders type II and III calcaneal fractures, the STA-PLA technique offers superior perioperative efficiency and a significantly lower rate of complications, particularly deep wound infections.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The human heel bone, known as the calcaneus, is the largest bone in the foot and bears the full weight of the body with every step. When this bone shatters from a high fall, the injury is severe, often involving the joint surface that connects the heel to the ankle. For decades, surgeons have faced a difficult choice in how to fix these broken bones. The traditional method involves making a large, L-shaped incision on the side of the foot to peel back the skin and muscle, exposing the entire bone so it can be reset and held together with metal plates. While this offers a clear view of the damage, the large cut disrupts the delicate blood supply to the skin, frequently leading to wound infections or tissue death that can require further surgery. To avoid these risks, surgeons developed a less invasive technique using smaller cuts, but these limited views sometimes made it harder to perfectly align the bone fragments or secure them firmly enough for early recovery. The central question for patients and doctors has been whether the safety of smaller cuts outweighs the potential difficulty of the repair, or if the traditional wide-open approach remains the only way to ensure a perfect fix.
A team of researchers at Fudan University in China set out to answer this question by comparing two specific surgical strategies on 150 patients who had suffered from displaced fractures of the heel bone. They divided the patients into two equal groups. One group received the traditional wide-open surgery, while the other group underwent a newer, combined approach that utilized two small incisions instead of one large one. In this combined method, surgeons made a small cut over the sinus tarsi, a natural depression on the side of the foot, to look directly at the broken joint surface. They then made a second small cut behind the heel bone and created a tunnel under the skin to slide a metal locking plate into place without peeling back the entire side of the foot. This technique allowed them to use the same strong metal plate as the traditional method but with far less disturbance to the skin and soft tissues.
The results of the study showed that the combined approach offered significant advantages in the immediate aftermath of the surgery. Patients in the combined group were able to undergo their operations much sooner after their injury, with an average wait of just over three days, compared to eight days for those receiving the traditional wide-open surgery. This shorter wait was possible because the smaller incisions did not require the swelling to subside as much before the surgeon could safely proceed. During the operation, the combined group also experienced less blood loss and shorter surgery times, and they spent nearly half as many days in the hospital as the other group. The only trade-off was that the surgeons using the combined method needed to use the X-ray machine slightly more often during the procedure to ensure the metal plate was positioned correctly through the small openings.
When the researchers looked at the long-term results, they found that both methods were equally successful at restoring the shape of the heel bone and the angles that determine how well the foot functions. By the time patients were checked again roughly two years later, the bone had healed completely in everyone, and both groups reported excellent ability to walk and stand, with no significant difference in their final scores of pain and function. However, the safety profile of the two methods was starkly different. The group that received the traditional wide-open surgery experienced complications in one out of every five patients. These issues included wound infections that required additional surgery to clean out deep tissue and remove the metal hardware. In contrast, the group with the combined approach had a complication rate of only about one in fifteen, and the issues that did arise were minor, such as small areas of skin healing slowly or temporary numbness, none of which required further surgery.
The study concludes that while both surgical methods can successfully fix a broken heel bone and restore a patient's ability to walk, the combined approach of using two small incisions with a metal plate is safer and more efficient. It allows for faster surgery, shorter hospital stays, and a much lower risk of serious infection, particularly for patients whose soft tissues are at high risk of damage. The researchers suggest that this method represents a significant improvement for treating these complex fractures, offering the strength of a rigid metal fixation without the heavy toll on the skin that often accompanies the traditional wide-open technique.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.