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J Bone Joint Surg Am. 2014 Feb 19;96(4):302-9. doi: 10.2106/JBJS.L.01215.

Displaced intra-articular calcaneal fractures treated in a minimally invasive fashion: longitudinal approach versus sinus tarsi approach.

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Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, Hebei, Republic of China. E-mail address for T. Zhang: E-mail address for Y. Su: E-mail ad.



The optimal treatment for displaced intra-articular fractures of the calcaneus remains controversial. This study aims to assess the clinical outcomes of a minimally invasive longitudinal approach compared with the sinus tarsi approach in the surgical treatment of these fractures.


Patients with a displaced intra-articular fracture of the calcaneus who were admitted to the trauma center of our hospital from September 2009 through April 2010 were randomly assigned to treatment using one of these two surgical techniques. All patients underwent the same standardized postoperative rehabilitation protocol. Functional outcome was assessed by using the American Orthopaedic Foot & Ankle Society scores. Linear regression analysis was performed to identify the potential influencing factors for functional outcomes.


One hundred and sixty-seven patients who met the inclusion criteria were included in the study. Thirty-seven patients were lost to follow-up for various reasons, and the remaining 130 patients were followed for an average of twenty-seven months. Sixty-nine fractures in sixty-three patients were treated using a minimally invasive longitudinal approach (the MILA group), and seventy-two feet in sixty-seven patients were treated with a sinus tarsi approach (the STA group). The two groups were comparable in terms of age, sex, fracture type, and time from injury to operation. The operative time in the MILA group was significantly shorter than that in STA group (p < 0.05). Wound-healing complications were 2.9% in the MILA group and 12.5% in the STA group. The average time to the start of progressive weight-bearing exercise was 5.3 weeks in the MILA group and 5.6 weeks in the STA group (p > 0.05). The good and excellent results in the two groups were comparable for the Sanders type-II and III calcaneal fractures (p > 0.05), but the good to excellent rate in the STA group was significantly higher for the Sanders type-IV fractures (p < 0.05). Linear regression analysis showed that surgical technique, Sanders classification, and the time to the start of weight-bearing activity have a significant influence on functional outcomes.


Outcomes are similar for the minimally invasive longitudinal and sinus tarsi surgical approaches in the treatment of Sanders type-II and III displaced intra-articular fractures of the calcaneus, with the benefit of a lower complication rate and shorter operative time for the minimally invasive technique. For Sanders type-IV fractures, however, the sinus tarsi approach appears to be the treatment of choice.

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