Sinus Tarsi Approach for Calcaneal Fracture Treatment: Our Experience with 36 Consecutive Cases

was used in all cases after exsanguination.Approximately 5-7 cm long incision was made starting from 1 cm below the tip of lateral malleolus extending anteriorly in the line of the fourth metatarsal.Subcutaneous tissue was dissected.Care was taken to avoid injury to the sural nerve.Sinus tarsi fat pad was mobilized, and the origin of extensor digitorum brevis was elevated sharply and reflected dorsally and distally along with an inferior attachment of the extensor retinaculum.The peroneal sheath was sharply dissected and tendons were retracted inferiorly.Subtalar joint was exposed by capsulotomy and the posterior facet of calcaneum was identified.In pure tongue depression type fractures, the facet was elevated using the Essex Lopresti maneuver, while in thalamic depression fractures, a periosteal elevator was passed below the depressed fragment to elevate the posterior facet.Alternatively, a novel technique invented by the senior author was used in which multiple drill holes are made with 3.2 mm drill bit over tuberosity just below Tendoachilles (TA) insertion and a vertical slit was created to pass a Kirschner wire (k-wire) for use as a joystick, and the depressed thalamic fragment was elevated under fluoroscopy guidance (Figs 4A-C).Then the reduction was assessed in axial view.If the medial wall was not reduced then a Schanz screw was passed from tuberosity anteriorly to exert valgus force and simultaneously a small bone spike was passed between the body and sustentaculum fragment Surgical ProcedureThe surgery was done with the patient in a lateral decubitus position after administration of spinal anesthesia.