Treatment of Sanders type II and III calcaneal fractures involving posterior superior calcaneal body with lateral straight “three-window” incision combined with a microvariable-angle locking plate

Abstract Background: We compared the therapeutic outcomes of patients operated on via the three-window lateral straight approach (TWLSA) and sinus tarsi approach (STA) with a microvariable-angle locking plate for the treatment of Sanders type II and III calcaneal fractures involving the posterior superior calcaneal body. Methods: We reviewed 100 patients with Sanders II or III calcaneal fractures involving the posterior superior calcaneal body from February 2018 to February 2021. Sixty patients were treated with the TWLSA, and 40 were treated with the STA. The Böhler angle, Gissane angle, height, width, and length were evaluated preoperatively, immediately after surgery and at the last follow-up. The operation time and fluoroscopy times were recorded. The American Orthopedic Foot and Ankle Society (AOFAS) scorewas used to evaluate foot function and record complications. Results: Pre- and postoperative radiologic parameters were significantly different in both groups (both P＜0.05). Neither the postoperative nor the last follow-up radiologic parameters differed significantly between the 2 groups (both P > 0.05). The operation time and fluoroscopy times in the TWLSA group were significantly lower than those in the STA group (both P<0.05). At the last follow-up, the AOFAS scores averaged 92 (83-99) inthe TWLSA group and 91 (81-99) in the STA group, but this difference was not statistically significant. Sural nerve injury occurred in 6 cases of TWLSA and 4 cases of STA, and this difference was not statistically significant. Incision infections did not occur in either group. Conclusions: Compared with the STA, the TWLSA afforded comparable radiological results, clinical outcomes and complications for the treatment of Sanders II and III calcaneal fractures involving the posterior superior calcaneal body but reduced operation time and fluoroscopic times.