Surgeon Learning Curve for the Sinus Tarsi Approach to Intra-articular Calcaneus Fractures: Improvement With Experience

Abstract

Objective: To analyze the relationship between surgeon experience with the sinus tarsi approach (STA) and outcomes in the treatment of displaced intra-articular calcaneus fractures. Setting: Single level 1 trauma center. Design: Retrospective study. Patients/Participants: 103 consecutive patients with displaced intra-articular calcaneus fractures OTA/AO (Orthopaedic Trauma Association/AO Foundation 82C; Sanders II–IV) treated operatively using STA from 2015 to 2021 were enrolled. Intervention: Open management using the STA performed by 2 fellowship-trained orthopaedic traumatologists. Main Outcome Measurement: Quality of anatomic reduction based on postoperative CT scans and standard radiographs. Results: Sixty-six patients met inclusion criteria. Patients were primarily men (75.8%) with a mean age of 41 years (range 20–71 years), including 14 smokers (21.2%), 9 diabetics (13.6%), and 10 open fractures (15.2%). Sanders III fractures were most common (68.2% vs. 28.5% and 6.1% Sanders II/IV, respectively). Reduction quality was predominantly good (59.1%, n = 39) or excellent (25.8%, n = 17). Complications included wound necrosis (1), superficial infection (1), deep infection (1), and symptomatic posttraumatic arthritis requiring arthrodesis (3). There was a 29.3% reduction in likelihood of surgical complication with each year in surgeon experience with the STA and an 8.9% reduction per case (P < 0.001). The likelihood of achieving a good or excellent reduction was 1.8 and 2.3 times greater than achieving a fair reduction, respectively, for each year increase in surgeon experience with the STA (P = 0.012 and 0.007, respectively). For each successive case, there was a 1.2 times greater likelihood of achieving a good reduction (P = 0.03). Conclusion: Surgeon experience plays a critical role in outcomes. We found that outcomes (reduction and complications) improve with each cumulative case and year of experience with the STA to treat displaced intra-articular calcaneus fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.