gms | German Medical Science

Objectives: This study should mainly compare complications like wound edge necrosis, infection and sural nerve lesions in 265 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 265 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 265 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 2018 265 cases were treated with the sinus tarsi approach and C-nail including 62 Sanders-Types III/IV (23.4%) and 6 open fractures (2.3%). The average age of patients was 47 years (17-73). 120 patients (45.3 %) were heavy smokers, 20 (7.5 %) were non-insulin dependend diabetic patients. Böhler's angle was improved in average from 5.9° preoperatively to 32.1° postoperatively, the posterior facet step off from 5.6 mm to 0,7 mm respectively. Clinically according the average AOFAS score 12 months after surgery was 90.5 (75-100). Despite 6 open fractures (2.3 %) and 140 patients with risks of health (52.8 %) only three wound edge necrosis (1.1 %), 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).Important also that our case of deep infection was cured only by C-nail removal and lavage, requireing wether bone resection nor arthrodesis.

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 1.1 % vs 9.9 % and a more than 3 times lower infection rate of 0.8 % vs 3.0 % is found, 0.0 % sural nerve damage vs 19%.