Calcaneus fractures of Sanders' types II and III treated with modified calcaneal plate via the sinus tarsi approach

Objective To discuss the reduction and internal fixation for calcaneal fractures of Sanders types Ⅱ and Ⅲ with modified calcaneal plate through the sinus tarsi approach.Methods Open reduction and internal fixation via the sinus tarsi approach with modified calcaneal plate was performed from June 2012 to December 2013 in 20 patients with intra-articular calcaneal fracture (24 sides).They were 16 men (19 feet) and 4 women (5 feet),18 to 58 years of age (average,36.5 years).According to the Sanders classification,15 feet were of type Ⅱ and 9 feet of type Ⅲ; according to Essex-Lopresti classification,10 feet were of the tongue type and 14 feet of the joint depression type.Postoperatively,wound complications were observed and X-ray films were evaluated carefully to assess the calcaneal length,width,height,B(o)hler's and Gissane' s angles.Functional recovery was evaluated according to the ankle and hind foot score of American Orthopedic Foot and Ankle Society (AOFAS).Results Altogether 20 patients (24 feet) were followed up for an average of 12.3 months (from 6 to 18 months).There were no severe wound complications.X-ray showed basic restoration in the length,width,height,B(o)hler's and Gissane's angles of the calcaneus and noloss of reduction during the follow-up period.The AOFAS scoring showed:10 excellent,4 good and one fair cases in the 15 feet of Sanders type Ⅱ fracture; 4 excellent,3 good and 2 fair cases in the 9 feet with Sanders type Ⅲ fracture; 7 excellent and 3 good cases in the 10 feet of the tongue type; 7 excellent,4 good and 3 fair cases in the 14 feet of the joint depression type.Conclusions Surgical treatment of calcaneal fractures of Sanders' types Ⅱ and Ⅲ with modified calcaneal plate via the sinus tarsi approach can result in advantages of good exposure and reduction,limited wound complications and reliable fixation.However,long-term outcomes need to be further observed. Key words: Calcaneus fracture;  Fracture fixation, internal;  Bone plate;  Sinus tarsi approach