SLR - January 2020 - Marissa Mogavero
Reference: Zhao, Bin, Wenqian Zhao, and Isaac Assan. "Steinmann Pin Retractor-Assisted Reduction with Circle Plate Fixation Via Sinus Tarsi Approach for Intra-Articular Calcaneal Fractures: A Retrospective Cohort Study." Journal of orthopaedic surgery and research 14.1 (2019): 363.Scientific Literature Review
Reviewed By: Marissa Mogavero, DPM
Residency Program: Beaumont Wayne Hospital, Wayne, MI
Podiatric Relevance: Displaced calcaneal fractures have the potential of leading to post-traumatic osteoarthritis and significant disability. Due to difficulty in obtaining reduction through non-operative management, open reduction internal fixation is the gold standard for treatment. The extensive lateral L-shaped incision is often used due to its notable advantage of exposure of the calcaneal body over the sinus-tarsi approach. However, approximately 30 percent of patients experience wound healing complications including necrosis, dehiscence and infection. This study aimed to look at the sinus tarsi approach using Steinmann pin retraction and a circle plate to restore the posterior facet, height, length and width of the calcaneus with earlier return to function and decreased wound complications.
Methods: This study reviewed clinical data of fifteen patients with closed intra-articular calcaneal fractures who were surgically managed using Steinmann pin retractor-assisted reduction with circle plate fixation via the sinus tarsi approach. All fractures were classified preoperatively using the Sanders classification and all patients were classified type II or III. Patients were clinically and radiographically evaluated for six months. The clinical evaluation included use of the visual analogue scale (0 = no pain, 10 = maximum pain) and the AOFAS Ankle-Hindfoot score.
Results: There were no cases of sinus tarsi syndrome, compartment syndrome or wound complications. All fifteen patients had a normal alignment of the calcaneus and stable plantigrade foot. At final follow-up the VAS score was noted to be an average of 1.44 and the AOFAS Ankle-Hindfoot score was an average of 84.31. The radiographic evaluation revealed restoration of the joint surface with no hardware complications. The Bohlers angle and calcaneal width, length and height were significantly improved post-operatively.
Conclusions: The sinus tarsi approach for management of calcaneal fractures has the advantage of minimal wound complications as well as good visualization of the posterior facet. However, it has been noted that due to poor visualization of the lateral calcaneal wall this proves difficult in restoring the alignment. In this study, the authors showed that Steinmann pin retraction provided a stable distraction to allow for restoration of the length and height of the calcaneal body. The circle plate is normally used with the extensile lateral L-shaped incision however, the authors found that it could be used with the sinus tarsi approach to provide maximal coverage and stability of the calcaneal body with maintenance of alignment. The authors concluded that Steinmann pin retractor-assisted reduction with circle plate fixation via the sinus tarsi approach may be a safe and effective surgical treatment option for Sanders type II and III calcaneal fractures.