Abstract:[Objective] To compare the clinical efficacy of open reduction and internal fixation with plate through tarsal sinus approachversus closed reduction and percutaneous screw fixation for Sanders type Ⅱ and Ⅲ calcaneal fractures. [Methods] A retrospective analysiswas performed on 43 patients who had Sanders type Ⅱ and Ⅲ calcaneal fractures treated surgically from July 2019 to January 2022. Ac-cording to doctor-patient communication, 23 patients were treated with open reduction and plate fixation through tarsal sinus approach (thetarsal sinus group), while other 20 patients underwent closed reduction and percutaneous screw fixation (percutaneous group). The perioper-ative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had operation completed success-fully. The sinus tarsi group consumed significantly longer operation time [(81.7±12.7) min vs (71.9±13.9) min, P=0.020], with significantlygreater incision length [(5.6±1.1) cm vs (1.9±0.6) cm, P＜0.001], more intraoperative blood loss [(56.7±26.8) mL vs (14.1±8.7) mL, P＜0.001], the hospital stay [(7.3±2.0) days vs (5.5±1.4) days, P＜0.001] and poorer incision healing grade [A/B/C, (17/3/3) vs (20/0/0), P=0.048] than the percutaneous group, whereas the former had significantly less intraoperative fluoroscopy times than the latter [(7.1±2.6)times vs (10.4±2.7) times, P＜0.001]. The patients in both groups were followed up for (18.7±5.9) months in a mean, and the VAS, AOFASscores, as well as inversion-eversion ROM in both groups were significantly improved over time (P＜0.05). The tarsal sinus group had signif-icantly less inversion-eversion ROM than the percutaneous group 1 month postoperatively [(30.9±5.6)° vs (40.0±4.5)°, P＜0.001]. Regardingimaging, the Bohler angle, Gissane angle, calcaneus length, calcaneus width, and calcaneus height were significantly improved in bothgroups immediately after surgery and at the last follow-up compared with those preoperatively. At the last follow-up, the tarsal sinus groupproved significantly better than the percutaneous group in terms of B?hler angle [(29.1±1.6)° vs (27.3±1.8)°, P＜0.001] and calcaneus height [(45.9±2.3) mm vs (43.7±2.3) mm, P=0.003]. Furthermost, the former was also significantly superior to the latter regarding to cartilage sur-
face collapse [(1.4±0.7) mm vs (2.5±1.1) mm,
P<0.001; (2.0±1.2) mm vs (4.1±1.6) mm,
P<0.001] 6 months postoperatively and at the latest
follow-up.
[Conclusion] Both methods are effective for the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. By comparison, the
open reduction and plate fixation through tarsal sinus approach takes advantage of more reliable fixation strength and stability, while the
closed reduction and percutaneous screw fixation has the advantage of minimally invasive surgery.