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

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.