Limited sinus tarsi approach versus extended lateral approach for the open reduction and internal fixation of Sanders type III calcaneal fractures: a retrospective cohort study

Controversy still exists regarding whether the sinus tarsi approach can effectively manage the Sanders type III fractures. The objective of this retrospective study was to describe and evaluate the clinical applications of the limited sinus tarsi approach and the extended lateral approach for treating Sanders type III calcaneal fractures. Between January 2020 and February 2023, 35 patients with calcaneal fractures (Sanders type III) treated in our trauma center were enrolled in this retrospective study. Surgeries were performed after improvement of soft tissue conditions. Either limited ORIF via sinus tarsi approach (limited sinus tarsi approach group, ST group) or ORIF via extended lateral approach (extended lateral approach group, EL group) was performed on these patients. Clinical evaluation indicators including time to surgery, time for surgery, complications, subtalar joint stiffness, traumatic arthritis, SF-36, VAS, AOFAS score, Böhler’s angle as well as Gissane's angle were recorded and compared between these two groups. The waiting time before surgery in ST group was significantly shorter than that in the EL group. The mean operative time was significantly higher than that in the EL group. No significant difference with respect to the AOFAS score, VAS score and SF-36 score between the groups was manifested. Subtalar stiffness occurred in 3 cases in the ST group while 7 cases in the EL group. 2 cases in EL group and one case in the ST group presented with subtalar traumatic arthritis and the symptoms subsided after treatment. The difference regarding the Böhler angle and Gissane angle between groups were not statistically significant. With the lower incidence of soft tissue complications and subtalar joint stiffness, treatment of calcaneal Sanders III fracture through the sinus tarsal incision can be performed as one of the routine options.