الفهرس 
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Abstract
Intra-articular fractures of the calcaneus are one of the most challenging fractures to orthopedic surgeons. The aim of the operation is to achieve anatomical reduction of the subtalar joint, maintaining length & alignment to achieve a good functional outcome. In this series, we do comparison between the sinus tarsi approach and the standard lateral extensile approach in calcaneal fractures fixation.
One hundred and ninety nine patients with 255 fractures with mean age 33.1±12.36 years were included. Only two hundred and twenty five fractures met the inclusion criteria. 45.9% of the fractures were classified as Sanders II and 54.1% of the fractures were classified as Sanders III. All of them were treated operatively within 21 days of trauma. All patients were evaluated clinically using AOFAS ankle / hindfoot score and radiologically. The mean follow up duration was 12 months.
Immediate postoperative X-rays showed anatomical articular reduction. Clinical outcomes of both groups at 12 months’ follow-up showed that sins tarsi group AOFAS (81.91 ± 8.08) was higher than lateral extensile group 68.48 ± 7.39 with highly significant p value 0.000 while AOFAS was comparable in both groups in Linbo Zhuang, Hao Xu and Je-Hyoung Yeo, studies with insignificant P value 0.536, 0.356, >0.05 respectively.
Complication, wound complications in the current study were higher in the lateral extensile group with a significant P-value of 0.02. It is noted it was also higher in the lateral extensile group in the previous studies with significant p values except in Linbo Zhuang which showed that using the same locking plate led to the same complications without a difference.
Sub-talar arthritis in the current study was higher in the lateral extensile group with a highly significant P value of 0.000. It is also higher in the lateral extensile group in previous studies but with an insignificant P-value. Two cases in the current study were not well fixed and revision was done. The secondary procedures including metal removal or arthrodesis were higher in the lateral extensile approach in this study.
Other complications as sural nerve palsy was comparable in both groups while metal irritation and peroneal tendinitis were higher in the lateral extensile group but with an insignificant P-value. According to secondary procedures, one case in each group needed revision as there was not adequate fixation. Fifteen cases out of twenty cases of infection in lateral extensile needed debridement and metal removal , while other five cases treated conservative. While in sinus tarsi group. One case out of three infected cases needed debridement and metal removal while others treated conservative.
Sub-talar arthrodesis needed in 36 cases in lateral extensile group while 4 cases in sinus tarsi group .
Radiological assessment using Bohler and Gissane angles in the current study. Bohler angle in the current study was higher in the sinus tarsi group while in Gissane angle was higher in the lateral extensile groups with a highly significant P-value of 0.000 while these angles were comparable in Linbo Zhuang and Hao Xu studies with insignificant P values.
The type of Sanders classification was found to correlate significantly with the time needed to fracture healing with p value of 0.000.