Extensile Lateral Approach was found to be Efficient for Qua
A Study was conducted to evaluate the difference in the quality of fracture reduction between the sinus tarsi approach (STA) and extensile lateral approach (ELA) using postoperative Computed Tomography (CT) scans in displaced intra-articular calcaneal fractures (DIACFs).

Consecutive patients undergoing operative fixation of DIACFs with postoperative CT scans and standard radiographs were included. Cases were divided into 2 groups based on ELA versus STA.

Bohler angle and Gissane angle were evaluated on plain radiographs. CT reduction quality grading included articular step off/gap within the posterior facet, and varus angulation of the tuberosity: CT reduction grading included: excellent (E): no gap, no step, and no angulation; good (G): less than 1 mm step, less than 5 mm gap, and/or less than 5° of angulation, fair (F): 1–3 mm step, 5–10 mm gap, and/or 5–15° angulation; and poor (P): more than 3 mm step, more than 10 mm gap, and/or more than 15° angulation.

Results:
--77 patients with 83 fractures were included. Average age was 42 years, with 57 men. 4 fractures were open.

--There were 37 Sanders II and 46 Sanders III fractures; 36 fractures were fixed using the STA, whereas 47 used the ELA.

--Average days to surgery were 5 for STA and 14 for ELA. A normal Bohler angle was achieved more often with the ELA (91.5%) than with STA (77.8%).

--There was no difference by approach for Gissane angle. ELA had better overall reduction quality.

--For Sanders II, there was no difference in reduction quality with STA versus ELA.

--For Sanders III, ELA trended toward better reduction quality.

Finally, on plain radiographs, the ELA had a better overall reduction of the Bohler angle, as well as the posterior facet and tuberosity on postoperative CT scans. There was no difference between STA and ELA for Sanders type II DIACFs. Importantly, ELA tended to improve reduction quality for Sanders III DIACFs.

Source: https://journals.lww.com/jorthotrauma/Abstract/2021/06000/Quality_of_Reduction_of_Displaced_Intra_articular.1.aspx
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