Comparison of Sinus Tarsi Versus Percutaneous Surgery in Displaced Intra-Articular Calcaneal Fractures: Clinical, Radiological, and Pedobarographic Outcomes

Objective: The objective is to compare the clinical, radiological, and pedobarographic outcomes of patients with intra-articular calcaneal fractures treated with sinus tarsi approach (STA) or percutaneous screw fixation postoperatively. Methods: A consecutive cohort of 66 patients who underwent STA or percutaneous screw fixation for calcaneal fractures between January 2020 and June 2023 was documented. Patients who were at least 18 years of age and had more than 12 months post-operative follow-up were included in the study. Patients with orthopedic injuries to the ipsilateral or contralateral lower extremity, a prior history of lower extremity surgery, congenital deformities, neurological disorders, the utilization of drugs that may influence walking patterns and stability, open foot wounds, or any mental condition that could impair walking were excluded from the study. Results: Of the patients, 24 underwent percutaneous screw fixation, while 42 underwent mini-open STA. No significant statistical differences were identified between the two groups in terms of demographic data, except for fracture classification. More advanced fracture patterns were observed in the sinus tarsi group. While statistically significant differences were found in the Talo-first metatarsal angle (P = .001), Talonavicular coverage angle (P = .001), Meary’s angle (P = .001), and the angle between the medial cuneiform and fifth metatarsal (P = .022), no differences were observed in other radiological measurements. Clinically, significant differences in American Orthopaedic Foot and Ankle Society (AOFAS) (P = .005) and visual analog scale (VAS) (P = .049) scores were observed between the two groups. In dynamic pedobarographic analysis, when comparing the injured and uninjured extremities, significant differences were observed in the injured extremity of the sinus tarsi group in terms of forefoot maximum force (N) (P = .001) and hindfoot maximum pressure (N/cm2) (P = .001). Conclusion: While the STA group showed better functional and radiological outcomes, pedobarographic analyses revealed deficiencies in pressure and force distribution in the injured extremity within the STA group. These findings suggest that discrepancies in load and pressure distributions may not always be associated with functional and radiological outcomes, and despite consisting of patients with more severe fractures, ensuring the opening of the posterior facet and achieving joint reduction would increase patient satisfaction rates.