gms | German Medical Science

Objectives: This study should mainly compare complications like wound edge necrosis, infection and sural nerve lesions in 228 own cases using a sinus tarsi approach and interlocking calcaneal nail with 1.039 cases from literature using an extended lateral approach with plate fixation.

Methods: In a prospective, consecutive study for 228 calcaneal fractures x-rays and CT-scans for measuring Böhler's angle and the amount of dislocation of the posterior facet fragment were taken, both pre- and postoperatively. All Sanders-Types I to IV, closed or open, were consequently treated with the sinus tarsi approach and C-nail. Havy smokers and patients with non-insulin dependend diabetes mellitus were not excluded for operation. The 3 complication rates of these 228 cases were compared with 1.039 out of 7 international studies with a case load >100, published between 1993-2003 (cited in [1] p. 445).

Results: Between 2011 to 2017 228 cases were treated with the sinus tarsi approach and C-nail including 50 Sanders-Types III/IV (22%) and 6 open fractures (2.6%). The average age of patients was 47 years (17–73). 110 patients (48.2 %) were heavy smokers, 20 (8.8%) were non-insulin dependend diabetic patients. Böhler's angle was improved in average from 6,2° preoperatively to 31,8° postoperatively, the posterior facet step off from 5,0 mm (0–35 mm) to 1,0 mm (0–5 mm) respectively. Clinically according to AOFAS 162 patients counted 92 (65–100) points 6 months after surgery, 110 patients 90.3 points (75–100) 12 after months. Despite 6 open fractures (2.6%) and 130 patients with risks of health (57%) only three wound edge necrosis (1.3%), one superficial and one deep infection (0.8%) were seen whereas in literature using an extended lateral approach and plate fixation wound edge necrosis in 9.9% (3.9–16.0) and infection in 3.0% (0.0–6.1) were reported. The most striking result related to sural nerve damage was the rate of 0.0% in the own study versus 19 % counted by Makki et al. (2010), the highest rate of all.

Conclusion: Using the mini-open sinus tarsi approach and the C-nail compared to the extended lateral approach with plate fixation in literature a significant lower wound edge necrosis rate of 1.3% vs 9.9% and a more than 3 times lower infection rate of 0.8% vs 3.0% is found.