Deplase eklem içi kalkaneus kırıklarının cerrahi tedavisinde genişletilmiş lateral ve sinüs tarsi yaklaşımlarının klinik ve radyolojik sonuçlarının karşılaştırılması

Year 2022, Volume: 47 Issue: 4, 1591 - 1599, 28.12.2022

Kemal Şahan , Abdulkadir Polat , Feyzi Kılıç , Cengiz Kazdal , Fırat Fidan , Ufuk Özkaya

https://doi.org/10.17826/cumj.1164835

Cited By: 2

Abstract

Amaç: Bu çalışmanın amacı eklem içi kalkaneus kırıklarının açık redüksiyon internal fiksasyonunda Sinüs tarsi(ST) ve Lateral extansil(LE) yaklaşımları arası klinik ve radyolojik sonuçların karşılaştırılmasıdır.
Gereç ve Yöntem: Kliniğimizde 2012-2017 yıllarında cerrahi yöntemle tedavi edilen 48 hastanın 51 kalkaneus kırığı retrospektif olarak incelendi. Hastalar iki grup olarak ayrıldı, preoperatif BT, erken postroperatif ve postoperatif 1. yıl grafileri ve The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score skorları değerlendirildi.
Bulgular: Sanders sınıflamasına göre LE grubunda 9 hasta tip 2(%36), 16 hasta tip 3(%64), ST grubunda 8 hasta tip 2(%34,8), 13 hasta (%56,5) tip 3, 2 hasta(%8,7) tip 4 idi. Takip süresi ST’ de 16 ay (12-52), LE’ de 37 ay(16-70) idi. AOFAS-Hindfoot skoru 1. yılda ST grubunda 85(63-100), LE grubunda 83(52-93) bulundu. Cerrahi öncesi beklemesi süresi ST’ de ortalama 2(1-4) gün, LE’ de 6(3-12) gün olmak üzere daha kısa bulundu (χ2:5.22).
Sonuç: Sinüs tarsi yaklaşımının, eklem içi kalkaneus kırıkları cerrahisinde preoperatif bekleme süresinin kısalttığı, anatomik restorasyon için yeterli görüş sağladığı ve cilt komplikasyonlarından kaçınmak adına etkilidir.

Keywords

Kalkaneus, sinüs tarsi, minimal invaziv cerrahi, lateral ekstensil yaklaşım

Comparison of clinical and radiological outcomes between extended lateral and sinus tarsi approach in the surgical treatment of displaced intraarticular calcaneal fractures surgery

Abstract

Purpose: The aim of this stud was to compare the clinical and radiological results between Sinus-tarsi (ST) and Extended-Lateral (EL) approaches in open reduction internal fixation of intra-articular calcaneal fractures.
Materials and Methods: 51 calcaneal fractures of 48 patients surgically treated between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups. Preoperative CT, early postoperative and postoperative 1st-year radiographs, and The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score scores were evaluated.
Results: According to the Sanders classification, nine patients in the EL group were type 2(36%), 16 patients type 3 (64%), 8 patients in ST group type 234.8%), 13 patients (56.5%) type 3, 2 patients (8.7%) type 4. The mean AOFAS-Hindfoot score was 85(63-100) in the ST group and 83(52-93) in the LE group at one year. Mean preoperative waiting time was shorter, with an average of 2(1-4) days in ST and 6(3-12) days in LE.
Conclusion: ST approach shortens the preoperative waiting time in intra-articular calcaneal fracture surgery, provides a sufficient vision for anatomical restoration, and effectively avoids complications.

Keywords

Calcaneus, sinus tarsi, minimally invasive surgery, extended lateral approach

References

• Pitts CC, Almaguer A, Wilson JT, Quade JH, Johnson MD. Radiographic and Postoperative Outcomes of Plate Versus Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi. Foot Ankle Int. 2019 Aug;40(8):929-935. doi: 10.1177/1071100719848063. Epub 2019 May 14. PMID: 31088171.
• Yeo JH, Cho HJ, Lee KB. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach. BMC Musculoskelet Disord. 2015 Mar 19;16:63. doi: 10.1186/s12891-015-0519-0. PMID: 25886471; PMCID: PMC4391481.
• Bedigrew KM, Blair JA, Possley DR, Kirk KL, Hsu JR. Comparison of Calcaneal Exposure Through the Extensile Lateral and Sinus Tarsi Approaches. Foot Ankle Spec. 2018 Apr;11(2):142-147. doi: 10.1177/1938640017713616. Epub 2017 Jun 9. PMID: 28597687.
• Hospodar P, Guzman C, Johnson P, Uhl R. Treatment of displaced calcaneus fractures using a minimally invasive sinus tarsi approach. Orthopedics. 2008 Nov;31(11):1112. doi: 10.3928/01477447-20081101-08. PMID: 19226087.
• Li LH, Guo YZ, Wang H, Sang QH, Zhang JZ, Liu Z, Sun TS. Less wound complications of a sinus tarsi approach compared to an extended lateral approach for the treatment of displaced intraarticular calcaneal fracture: A randomized clinical trial in 64 patients. Medicine (Baltimore). 2016 Sep;95(36):e4628. doi: 10.1097/MD.0000000000004628. PMID: 27603354; PMCID: PMC5023876.
• Glueck DH, Mandel J, Karimpour-Fard A, Hunter L, Muller KE. Exact calculations of average power for the Benjamini-Hochberg procedure. Int J Biostat. 2008;4(1):Article 11. doi: 10.2202/1557-4679.1103. PMID: 21243075; PMCID: PMC3020656.
• Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016 Jun;15(2):155-63. doi: 10.1016/j.jcm.2016.02.012. Epub 2016 Mar 31. Erratum in: J Chiropr Med. 2017 Dec;16(4):346. PMID: 27330520; PMCID: PMC4913118.
• Zhang F, Tian H, Li S, Liu B, Dong T, Zhu Y, Zhang Y. Meta-analysis of two surgical approaches for calcaneal fractures: sinus tarsi versus extensile lateral approach. ANZ J Surg. 2017 Mar;87(3):126-131. doi: 10.1111/ans.13869. Epub 2017 Jan 25. PMID: 28122417.
• Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, Lamb SE; UK Heel Fracture Trial Investigators. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ. 2014 Jul 24;349:g4483. doi: 10.1136/bmj.g4483. PMID: 25059747; PMCID: PMC4109620.
• Koski A, Kuokkanen H, Tukiainen E. Postoperative wound complications after internal fixation of closed calcaneal fractures: a retrospective analysis of 126 consecutive patients with 148 fractures. Scand J Surg. 2005;94(3):243-5. doi: 10.1177/145749690509400313. PMID: 16259176.
• Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma. 1999 Jun-Jul;13(5):369-72. doi: 10.1097/00005131-199906000-00008. PMID: 10406705.
• Schepers T, Backes M, Dingemans SA, de Jong VM, Luitse JSK. Similar Anatomical Reduction and Lower Complication Rates With the Sinus Tarsi Approach Compared With the Extended Lateral Approach in Displaced Intra-Articular Calcaneal Fractures. J Orthop Trauma. 2017 Jun;31(6):293-298. doi: 10.1097/BOT.0000000000000819. PMID: 28538451.
• Schepers T. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review. Int Orthop. 2011 May;35(5):697-703. doi: 10.1007/s00264-011-1223-9. Epub 2011 Feb 19. PMID: 21336854; PMCID: PMC3080500.
• Park CH, Lee DY. Surgical Treatment of Sanders Type 2 Calcaneal Fractures Using a Sinus Tarsi Approach. Indian J Orthop. 2017 Jul-Aug;51(4):461-467. doi: 10.4103/ortho.IJOrtho_143_16. PMID: 28790476; PMCID: PMC5525528.
• Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int. 2013 Jun;34(6):773-80. doi: 10.1177/1071100713477607. Epub 2013 Mar 4. PMID: 23460669.
• Xia S, Lu Y, Wang H, Wu Z, Wang Z. Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures - a randomized controlled trial. Int J Surg. 2014;12(5):475-80. doi: 10.1016/j.ijsu.2014.03.001. Epub 2014 Mar 5. PMID: 24607889.
• Yao H, Liang T, Xu Y, Hou G, Lv L, Zhang J. Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. J Orthop Surg Res. 2017 Mar 14;12(1):43. doi: 10.1186/s13018-017-0545-8. PMID: 28288661; PMCID: PMC5348794.
• Sanders R. Intra-articular fractures of the calcaneus: present state of the art. J Orthop Trauma. 1992;6(2):252-65. doi: 10.1097/00005131-199206000-00022. PMID: 1602349.
• Weber M, Lehmann O, Sägesser D, Krause F. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2008 Dec;90(12):1608-16. doi: 10.1302/0301-620X.90B12.20638. PMID: 19043133.
• Lawrence SJ, Botte MJ. The sural nerve in the foot and ankle: an anatomic study with clinical and surgical implications. Foot Ankle Int. 1994 Sep;15(9):490-4. doi: 10.1177/107110079401500906. PMID: 7820241.
• Walde TA, Sauer B, Degreif J, Walde HJ. Closed reduction and percutaneous Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2-10 years. Arch Orthop Trauma Surg. 2008 Jun;128(6):585-91. doi: 10.1007/s00402-008-0590-1. Epub 2008 Feb 29. PMID: 18309507; PMCID: PMC2324129.
• Spierings KE, Sanders FRK, Nosewicz TL, Schepers T. Risk factors for surgical site infections with the Sinus Tarsi Approach in displaced intra-articular calcaneal fractures; a prospective cohort study with a minimum of one year follow-up. Injury. 2020 Jul;51(7):1676-1680. doi: 10.1016/j.injury.2020.05.004. Epub 2020 May 5. PMID: 32471686.
• Li S. Wound and Sural Nerve Complications of the Sinus Tarsi Approach for Calcaneus Fractures. Foot Ankle Int. 2018 Sep;39(9):1106-1112. doi: 10.1177/1071100718774808. Epub 2018 May 16. PMID: 29766742.
• Basile A, Albo F, Via AG. Comparison Between Sinus Tarsi Approach and Extensile Lateral Approach for Treatment of Closed Displaced Intra-Articular Calcaneal Fractures: A Multicenter Prospective Study. J Foot Ankle Surg. 2016 May-Jun;55(3):513-21. doi: 10.1053/j.jfas.2015.11.008. Epub 2016 Jan 23. PMID: 26810127.
• Zeng Z, Yuan L, Zheng S, Sun Y, Huang F. Minimally invasive versus extensile lateral approach for sanders type II and III calcaneal fractures: A meta-analysis of randomized controlled trials. Int J Surg. 2018 Feb;50:146-153. doi: 10.1016/j.ijsu.2017.12.034. Epub 2018 Jan 11. PMID: 29337175.
• Li Z, Wu X, Zhou H, Xu S, Xiao F, Huang H, Yang Y. Cost-utility analysis of extensile lateral approach versus sinus tarsi approach in Sanders type II/III calcaneus fractures. J Orthop Surg Res. 2020 Sep 18;15(1):430. doi: 10.1186/s13018-020-01963-5. PMID: 32948240; PMCID: PMC7501640.
• Okkaoğlu MC, Ateş A, Yaradılmış YU, Demirkale İ, Evren AT, Altay M. The necessity of bone grafting in the surgical treatment of severely comminuted calcaneus fractures. Cukurova Med J. 2019;44:27-32.
• Kikuchi C, Charlton TP, Thordarson DB. Limited sinus tarsi approach for intra-articular calcaneus fractures. Foot Ankle Int. 2013 Dec;34(12):1689-94. doi: 10.1177/1071100713510267. Epub 2013 Oct 22. PMID: 24151194.