Abstract / Summary
Abstract Background Minimally invasive techniques are being increasingly employed in calcaneal fractures (CFs) surgery to minimize soft-tissue complications. This retrospective cohort study (RCS) compared the combined sinus tarsi approach with the posterolateral approach (STA-PLA) and the extended lateral approach (ELA) for Sanders type II and III fractures using an atomical locking plate (ALP) to objectively assess the differences in clinical efficacy and safety. Method We conducted a RCS. 150 patients with CFs treated between January 2018 and December 2023 were identified and categorized into the STA-PLA group (n = 75) and the ELA group (n = 75) based on the treatment modality they received. The primary outcomes were operative parameters (surgical time, fluoroscopy frequency, blood loss) and complication rates. Secondary outcomes included hospitalization stay, radiographic reduction quality (Gissane's and Böhler's angles), and functional outcomes assessed by MFS and AOFAS score. Results The STA-PLA group demonstrated a significantly shorter injury-to-surgery interval and superior perioperative outcomes (operative time, blood loss, hospitalization duration) compared to the ELA group (all P < 0.05). Both groups showed significant postoperative improvement in Gissane's and Böhler's angles, with no intergroup difference. Functional scores (AOFAS, MFS) at final follow-up were excellent and comparable between groups. All patients achieved bony union without fixation failure. However, the overall complication rate was significantly lower in the STA-PLA group (6.67% vs. 20.00%, P < 0.05). Complications in the STA-PLA group were minor (wound necrosis, transient nerve injury), while the ELA group had five deep infections requiring reoperation. Conclusion Although both approaches yield outstanding final radiographic and functional outcomes, the STA-PLA technique demonstrates superior perioperative efficiency and a notably lower incidence of complications, particularly regarding deep wound infections. This represents a safe and efficacious approach for patients at high risk of soft-tissue complications. Surgeons should weigh the technical requirements against the benefits of this method.