Extended Lateral Approach Versus Double-window Approach For Treating Intra-articular Calcaneal Fracture

Background : Intra-articular calcaneal fractures is a serious and complex injury caused by a high-intensity impact such as a high-altitude fall or a motor vehicle accident.High-energy violence can cause serious deformities of the calcaneal bone shape and severe damage to the soft tissues.Therefore,intra-articular fractures of the calcaneus should take into account the treatment of fractures and the healing of soft tissues,and the occurrence of various late complications should be reduced as much as possible.Surgical treatment is essential for restoring the shape of the calcaneus,anatomically reducing intra-articular fractures,and reducing complications.However,the re-trauma of the incision will cause the soft tissue around the calcaneus to swell,split,and even expose internal fixation.Surgical approach is a key factor affecting soft tissue healing after surgery.The extended lateral approach causes greater damage to the soft tissues.The sinus tarsal approach is limited and the operation is difficult.Therefore,we designed the lateral double-window approach,which combines the advantages of adequate exposure of the extended lateral approach and low complication rate of the sinus tarsi approach.Objective:To explore the clinical efficacy of the lateral double-window approach for the treatment of intra-articular calcaneal fractures,and compare it with the extended lateral approach,to evaluate the application value of the lateral double-window approach.Methods: From January 2015 to January 2018,56 patients(61 feet)with intra-articular calcaneal fractures were treated at the Second Affiliated Hospital of Anhui Medical University.Of them,30 patients(33 feet)were operated via the double-window approach and 26 patients(28 feet)were operated via the extended lateral approach.The Waiting time before surgery,discharge time after surgery,calcaneal length,width,height,B?hler angel,Gissane angel,AOFAS score,VAS score and complications in both groups were recorded and compared.Results: The 2 groups were comparable because there were no significant difference between them in the general information(P>0.05).The preoperative waiting time of the two groups were(6.9±2.3)days and(10.3±1.8)days,respectively,and the postoperative discharge time of the two groups were(6.3±1.4)days and(7.7±1.7) days,respectively.The preoperative waiting time and postoperative discharge time of lateral double-window approach group were significantly shorter than those of the control group,and the difference was statistically significant(P<0.05).The length,width,height,B?hler angle and Gissane angle of the two groups at the last follow-up were improved compared with preoperatively,and the difference was statistically significant(P<0.05).There was no significant difference in B?hler angle,Gissane angle,length,width,and height between the two groups before and after operation(P>0.05).The AOFAS scores of the double-window approach group and the extended lateral approach group were 83.2±7.1 points and 84.0±7.6 points,respectively,VAS scores are(1.6±1.1)points and(1.8±1.1)points respectively,and the difference was not statistically significant(P>0.05).The incidence of wound complications(0)and the rate of subtalar joint stiffness(9.1%)in the double-window approach group were lower than those in the extended lateral approach group(25% and 42.9%),and the difference was statistically significant(P<0.05).Conclusion:The lateral double-window approach can provide sufficient exposure of the surgical field for direct reduction,and place a standard anatomical locking plate for fixation.Compared with the extended lateral approach,its preoperative waiting time and postoperative discharge time are shorter,and it can significantly reduce the incidence of wound complications and the rate of subtalar joint stiffness.The curative effect is satisfactory and it is worthy of promotion.