Screw-only Fixation of Calcaneal Fractures Using the Sinus Tarsi Approach

Abstract

Objective: Calcaneus is the most commonly fractured tarsal bone. This type of fracture may result from high-energy trauma or axial loading. The ideal treatment method for calcaneal fractures remains controversial in terms of surgical approach and the material that will be used for fracture fixation. This study aims to evaluate the outcomes of screw-only fixation in intra-articular calcaneal fractures using the sinus tarsi approach. Methods: Patients who were treated between 2014 and 2021 for calcaneal fractures were retrospectively investigated. Functional outcomes were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot-ankle score, and Gissane and Böhler angles were measured and compared. Results: The study included 32 patients (23 male, 9 female) who underwent screw fixation through the sinus tarsi approach for intra-articular calcaneal fractures. The mean age of the patients was 45.2 years. The fractures were classified according to the Sanders Classification, with 15 patients having type 2 fractures, 12 with type 3 fractures, and five with type 4 fractures. AOFAS hindfoot-ankle score revealed nine patients achieving excellent results, 14 patients achieving good results, and nine patients achieving fair results. AOFAS scores were lower in patients with Sanders type 4 fractures when compared to type 3 and type 2 fractures (p=0.005 and p<0.001 respectively). Conclusion: This study provides evidence supporting the favorable results of the sinus tarsi approach using screw-only fixation for treating intra-articular calcaneal fractures.