High incidence of post-operative infection after 'sinus tarsi' approach for treatment of intra-articular fractures of the calcaneus: a 5 year experience in an academic level one trauma center.

BACKGROUND: The optimal management of displaced intra-articular calcaneal fractures remains a topic of debate among trauma surgeons. The purpose of this study was to assess the safety of the sinus tarsi approach in regard to the incidence of deep infection and amputation following open reduction and internal fixation intra-articular calcaneal fractures.

METHODS: We conducted a retrospective chart review of all patients with displaced intra-articular calcaneus fractures treated with internal fixation through the sinus tarsi approach in a five year period. All surgeries were performed in a single level one trauma center by a single orthopedic trauma fellowship trained surgeon.

RESULTS: Seventeen patients with an average age of 36.6 ± 13.6 years (range 12-61 years) met the inclusion criteria. The time between injury and surgery was on average 6.1 days (range 1-22 days). Average follow up was 116 ± 78.2 days (range 3-276 days). Two patients (11.7%) had diabetes mellitus. None of the patients required amputation. Three patients (17.6%) developed deep infection and underwent subsequent formal irrigation and debridement, two of these requiring multiple repeat surgeries in addition to hardware removals. Negative pressure wound therapy and long term antibiotics via peripherally inserted central catheter (PICC) were necessary in these three patients with wound infections.

CONCLUSION: The sinus tarsi approach for intra fixation intra-articular calcaneal fractures is safe as compared to the traditional extensile approach in regard to flap necrosis and amputation. However, the rate of deep infection was higher than previously described in the literature.