Extensile lateral approach bests sinus tarsi approach in quality of fracture reduction

The Sanders classification was used. Cases were divided into 2 groups based on ELA versus STA. Bohler angle and Gissane angle were evaluated on plain radiographs. CT reduction quality grading included articular step off/gap within the posterior facet, and varus angulation of the tuberosity: CT reduction grading included: excellent (E): no gap, no step, and no angulation; good (G): <1 mm step, <5 mm gap, and/or <5° of angulation, fair (F): 1–3 mm step, 5–10 mm gap, and/or 5–15° angulation; and poor (P): >3 mm step, >10 mm gap, and/or >15° angulation.

The following findings were recorded-

a. Average age was 42 years (range, 18–74 years), with 57 men. Four fractures were open.

b. There were 37 Sanders II and 46 Sanders III fractures; 36 fractures were fixed using the STA, whereas 47 used the ELA.

c. Average days to surgery were 5 for STA and 14 for ELA (P < 0.001).

d. A normal Bohler angle was achieved more often with the ELA (91.5%) than with STA (77.8%) (P < 0.001).

e. There was no difference by approach for Gissane angle (P = 0.5). ELA had better overall reduction quality (P = 0.02).

f. For Sanders II, there was no difference in reduction quality with STA versus ELA (P = 0.51).

g. For Sanders III, ELA trended toward better reduction quality (P = 0.06).

Therefore, the authors concluded that "for Sanders type II DIACFs, there was no difference between STA and ELA. Importantly, for Sanders III DIACFs, ELA trended toward better reduction quality."

In addition to fracture reduction, surgeon learning curve, early wound complications, and long-term outcomes must be considered in future studies comparing the ELA and STA.