JAAOS - 2026-03-15 - Journal Article; Review
Calcaneus Fractures: A Review of Management, Treatment, and Recent Advances.
Schneiderman BA, Carlson BA, Johnson JP, Elsissy JG
Topics
Key Takeaway
The sinus tarsi approach (STA) reduces wound complication rates compared to the extensile lateral approach (ELA), with STA wound complication rates reported as low as 0–4% versus ELA rates of 10–25%.
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Summary
This narrative review examines the evolution of calcaneus fracture management, comparing the extensile lateral approach to the sinus tarsi and percutaneous techniques. The STA is presented as enabling earlier surgical intervention with wound complication rates of 0–4% versus 10–25% for the ELA. Restoration of Böhler angle, posterior facet congruity, and calcaneal width remain the primary surgical goals regardless of approach.
Key Limitation
As a narrative review without meta-analytic methodology, no quantitative synthesis of complication rates or functional outcomes is performed, limiting the ability to make evidence-based approach selection recommendations.
Original Abstract
Calcaneus fractures remain challenging fractures that are prone to complications. Surgery was previously restricted only to those with soft-tissue envelopes amenable to the extensile lateral approach. However, with the development of the sinus tarsi approach and other percutaneous techniques, more prompt surgical interventions with lower complication rates have become possible. Restoration of hindfoot morphology and facet congruity are the primary goals of surgery. Complications including posttraumatic subtalar arthritis, infection, wound dehiscence, and malunion can be minimized with deliberate treatment decisions.