Journal of Foot and Ankle Surgery - 2026-08-14 - Journal Article
Sinus Tarsi Approach for Sanders Type IV Calcaneal Fractures: Midterm Radiographic, Functional and Complication Outcomes.
Suer O, Eyceyurt RS, Uzakgider M, Tahta M, Kayali C
Topics
Key Takeaway
Sinus tarsi approach for Sanders type IV calcaneal fractures achieved a mean AOFAS hindfoot score of 81 and Böhler angle restoration from -6.4° to 22.4° at mean 58.2-month follow-up with a 14% reoperation rate and zero deep infections.
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Summary
This retrospective single-center series evaluated radiographic, functional, and complication outcomes of the sinus tarsi approach exclusively in Sanders type IV calcaneal fractures over a 10-year period. Böhler angle improved from -6.4° preoperatively to 22.4° postoperatively and was maintained at 20.4° at final follow-up; median AOFAS hindfoot score was 81 and median VAS was 2. Reoperation was required in 7 patients (14%), with no deep infections, malunions, or nonunions recorded.
Key Limitation
Absence of a comparator group (extensile lateral approach or primary subtalar arthrodesis) makes it impossible to determine whether the sinus tarsi approach confers superior, equivalent, or inferior outcomes for Sanders type IV fractures specifically.
Original Abstract
BACKGROUND
Sanders type IV displaced intra-articular calcaneal fractures are associated with severe comminution and poor outcomes. Evidence on the sinus tarsi approach remains limited.
PURPOSE
To evaluate radiographic restoration, functional outcomes, and complications after the sinus tarsi approach for Sanders type IV calcaneal fractures.
STUDY DESIGN
Retrospective single-center case series.
METHODS
We retrospectively reviewed a consecutive series of patients treated operatively using the sinus tarsi approach between January 2014 and January 2024. After predefined exclusions, 51 Sanders type IV fractures with minimum 24-month follow-up were included. Böhler angle, Gissane angle, calcaneal height, and calcaneal length were measured preoperatively, early postoperatively, and at final follow-up. Final pain and function were assessed using the visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Complications and reoperations were recorded.
RESULTS
Mean age was 45.5 ± 16.5 years, median time to surgery was 5 days, and mean follow-up was 58.2 ± 27.9 months. All radiographic parameters improved significantly over time (all p < 0.001). Böhler angle improved from -6.4 ± 9.8 degrees preoperatively to 22.4 ± 7.3 degrees early postoperatively and was 20.4 ± 7.4 degrees at final follow-up. Median final VAS and AOFAS hindfoot scores were 2 and 81, respectively. Reoperation was required in 7 patients (14%). No deep infection, malunion, or nonunion occurred.
CONCLUSION
The sinus tarsi approach was associated with satisfactory midterm radiographic and functional outcomes and acceptable complication and reoperation rates in Sanders type IV calcaneal fractures. Prospective comparative studies are needed to better define its role.