Title: Sinus tarsi approach for displaced, Intra-articular Calcaneal Fractures
Authors: Dr Manzoor Ahmad Halwai, Dr Mudasir Malik, Dr Mohammad Yaseen Rather, Dr Bashir Ahmad Mir, Dr Asif Sultan
The Calcaneus is the largest bone of the foot and is the major weight bearing osseous structure of the foot1. Calcaneal fracture fixation is regarding as one of the serious orthopaedic problems fraught with many complications ranging from osseous, soft tissue related and morbidity sometimes very high1,2,3.
Calcaneal fractures make up to 2 percent of all fractures, with a displacing intra articular fractures comprising 60 percent to 75 percent of these injuries2,4. There is a substantial economic implications associated with these fractures with as many 20 percent of people remain functionally incapacitated for up to three years after injury5.
With introduction of calcaneal plates in 1980, open reduction and internal fixation became standard5,6. But these were associated with high complication rates ranging from wound dehiscence, osteomyelitis, personal tendinitis, sural nerve injury, fibular abutment, calcaneocuboid arthritis, stiff foot and toes, weak gastrosoleus complex, fixed flat foot, chronic heal pain and complex regional pain syndrome3,7,8,9. Wound dehiscence and infection are particularly unique to this procedure2,6.
Conservative management has its own problems like subtalar osteoarthritis, subfibular impingement, complex regional pain syndrome and it seems logical to restore calcaneus to its anatomical contours7,10,11.
Minimally invasive osteosynthesis using sinus Tarsi approach can be a procedure between open reduction internal fixation using lateral extensive approach and conservative management1,3,4,12. It's advantages are restoration of anatomical contours of calcaneum like calcaneal height, width, restoration of calcaneal length, visualisation of posterior facet and no need for extensive lateral approach and no guilt of not restoring anatomy as in conservative treatment13,14.