Fixation with a mini-locking plate and percutaneous screws via mini-open sinus tarsi approach for calcaneal fractures of Sanders types II and III

Objective To evaluate the fixation with a mini-locking plate and percutaneous screws via the mini-open sinus tarsi approach for calcaneal fractures of Sanders types Ⅱ and Ⅲ.Methods Nineteen patients with closed calcaneal fracture were treated between February 2010 and February 2012.They were 12 men and 7 women,with an average age of 37.4 years (from 20 to 62 years).According to the Sanders classification,14 cases were type Ⅱ and 5 type Ⅲ.All cases were treated with internal fixation with a 2.4 mm mini-locking plate and percutaneous screws via the mini-open sinus tarsi approach following reduction of the posterior articular surface of the subtalar joint.Postoperatively,wound healing and complications were observed,and X-ray films and CT scans were evaluated carefully to determine fracture union.Functional recovery was evaluated according to the Ankle & Hind-foot Score of American Orthopedic Foot and Ankle Society (AOFAS).Results Seventeen patients were followed up for a mean duration of 16.2 months (12 to 24 months).Of them,one of Sanders type Ⅲ experienced delayed wound healing which was cured by local dressing change.No complication of wound infection or hardware failure was noted.Bone union was achieved at an average of 10.7 weeks (8 to 12 weeks).No obvious malunion occurred by the last follow-up.The B(o)hler angle increased significantly from 6.4° ± 5.5° preoperatively to 24.9° ± 4.1 ° at the last follow-up while the Gissane angle significantly from 96.1 ° ± 5.4° preoperatively to 110.7° ± 8.4° at the last follow-up (P ＜ 0.05).By the AOFAS scoring,8 cases were rated as excellent,6 as good and 3 as fair.Conclusions Fixation with a mini-locking plate and percutaneous screws via the mini-open sinus tarsi approach is an effective treatment for calcaneal fractures of Sanders types Ⅱ and Ⅲ,because it may lead to satisfactory reduction and stable fixation,and limit soft tissue complications as well. Key words: Calcaneus;  Fracture, bone;  Fracture fixation, internal;  Bone plates