Clinical Outcomes of Minimally Invasive Surgery in Sanders Type IV Intra-Articular Calcaneal Fractures

Jun Young Lee; Hyunwoong Jang; Young Wook Kim

doi:10.12671/jkfs.2019.12.4.181

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Lee, Jang, and Kim: Clinical Outcomes of Minimally Invasive Surgery in Sanders Type IV Intra-Articular Calcaneal Fractures

Original Article

J Korean Fract Soc 2019;32(4):181-187.

Published online: 10 January 2019

DOI: https://doi.org/10.12671/jkfs.2019.12.4.181

Clinical Outcomes of Minimally Invasive Surgery in Sanders Type IV Intra-Articular Calcaneal Fractures

Jun Young Lee, M.D., Ph.D., Hyunwoong Jang, M.D., Young Wook Kim, M.D.

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea

Correspondence to: Jun Young Lee, M.D., Ph.D. Department of Orthopaedic Surgery, School of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea Tel: +82-62-220-3147 Fax: +82-62-226-3379 E-mail: leejy88@chosun.ac.kr Financial support: This study was supported by research fund from Chosun University College of Medicine Scholarship. Conflict of interests: None

Received 14 March 2019 Revised 5 May 2019 Accepted 25 September 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study evaluated the radiologic and clinical results in patients who underwent minimal invasive surgery using sinus tarsi approach in Sanders type IV calcaneal fracture.

Materials and Methods

This retrospective study evaluated 13 cases of Sanders type IV calcaneus fractures that were treated by minimal invasive surgery using the sinus tarsi approach from July 2012 to April 2017. Further, these cases could be followed up for more than 12 months. Bone union, radiologic parameters such as Böhler's angle, Gissane's angle, calcaneal height, length, and width, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the postoperative complications were evaluated.

Results

Bony union was achieved in all the cases at the final follow up, and the mean union time was 5.5 months. One patient underwent reoperation for a surgical site infection, six patients had post traumatic arthritis, and two of them underwent subtalar joint fusion. The mean AOFAS ankle-hindfoot score was 81.2. At the final follow-up, the mean values of Böhler's angle and Gissane's angle were 20° and 119.8°, respectively, and the mean values of the calcaneus height, length, and width were 46.8 mm, 81.8 mm, and 45.6 mm, respectively.

Conclusion

Minimal invasive surgery using the sinus tarsi approach for Sanders type IV calcaneal fracture resulted in satisfactory anatomic reduction and stable fixation, and satisfactory clinical and radiologic results were obtained in most of the patients. Minimal invasive surgery is thought to reduce the soft tissue-related complications as compared to surgery using the extensile lateral approach.

Keywords: Sanders type IV, Calcaneus fracture, Sinus tarsi approach, Minimal invasive surgery

References

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Fig. 1.

(A) Preoperative X-ray and computed tomography showing a Sanders type IV and joint depressive type calcaneal fracture. (B) The postoperative X-ray showing restoration of the of Böhler's angle, Gissane's angle, and the calcaneus height, length, and width.

Fig. 2.

Photograph showing the sinus tarsi approach.

Fig. 3.

Intraoperative fluoroscope images showing posterior facet reduction using Schantz pin and fixation with 6.5 mm cannulated screws and K-wire.

Fig. 4.

Method of measurement of the calcaneal parameters.

Table 1.

Patients Demographics

Case No.	Age (yr)/ sex	Side	Injury mechanism	Sanders classification	Length of follow-up (mo)	Length of bone union (mo)	Implant
1	28/M	L	Fall down	IV	28	14	6.5 CS ×3 4.0 CS ×1 K-wire ×1
2	57/M	L	Fall down	IV	41	3	6.5 CS ×2 K-wire ×4
3	60/M	Both	Fall down	IV	21	3	R: 6.5 CS ×2 K-wire ×1 L: 6.5 CS ×2 4.0 CS ×1
4	36/M	R	Fall down	IV	14	4	6.5 CS ×2 4.0 CS ×1
5	67/M	R	Fall down	IV	21	3	6.5 CS ×2 4.0 CS ×1
6	39/M	Both	Fall down	IV	14	8	R: 6.5 CS ×2 K-wire ×2 L: 6.5 CS ×2 K-wire ×1
7	25/M	L	Fall down	IV	17	4	6.5 CS ×2 4.0 CS ×1
8	37/F	Both	Fall down	IV	14	3	R: 6.5 CS ×2 4.0 CS ×1 K-wire ×1 L: 6.5 CS ×2 K-wire ×2
9	45/M	R	Fall down	IV	12	6	6.5 CS ×2 K-wire ×2
10	18/M	L	Fall down	IV	12	7	6.5 CS ×2

4.0 CS ×1 M: male, F: female, L: left, R: right, CS: cannulated screw (unit: mm).

Table 2.

Clinical and Radiologic Results

Case No	Age (yr)/ sex	Preop Böhler's angle (°)	Preop Gissane's angle (°)	Preop calcaneus* (mm)	Last Böhler's angle (°)	Last Gissane's angle (°)	Last calcaneus* (mm)	Clinical results (AOFAS)	) Complication
1	28/M	–51	71	36/78/55	17	115	48/79/49	64	Post-traumatic OA, surgical site infection
2	57/M	23	102	49/87/41	22	121	51/82/40	74	Post-traumatic OA
3	60/M	R: 2 L: 1	R: 124 L: 147	R: 54/85/60 L: 42/87/56	R: 2 L: 11	R: 122 L: 118	R: 42/82/53 L: 42/88/55	R: 70 L: 80	Right post-traumatic OA
4	36/M	1	106	38/81/38	21	115	50/86/36	75
5	67/M	0	117	39/74/46	13	121	40/73/45	88	Post-traumatic OA
6	39/M	R: 36 L: 5	R: 114 L: 88	R: 48/73/48 L: 41/78/60	R: 39 L: 41	R: 124 L: 130	R: 44/76/48 L: 50/79/51	R: 81 L: 92	Right post-traumatic OA
7	25/M	11	122	50/87/47	21	115	56/90/45	95
8	37/F	R: –17 L: 4	R: 114 L: 122	R: 34/65/44 L: 33/68/45	R: 8 L: 24	R: 121 L: 121	R: 43/75/42 L: 43/75/43	R: 89 L: 90
9	45/M	–23	133	42/85/48	11	121	53/90/48	81	Post-traumatic OA
10	18/M	–29	135	33/84/40	30	114	46/89/38	76
Mean	–	–2.84	115	41.5/79.4/48.3	20	119.8	46.8/81.8/45.6	81.2
p-value	e	0.650	0.443	0.369/0.479/0.364	0.566	0.408	0.460/0.567/0.364	–

*Height/length/width. M: male, F: female, R: right, L: left, Preop: preoperative, OA: osteoarthritis.

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