Postoperative hindfoot alignment after sinus tarsi versus extensile lateral approach for Sanders type III-IV calcaneal fractures.

BACKGROUND: The optimal surgical approach for complex intra-articular calcaneal fractures remains controversial. This study aimed to compare the sinus tarsi (ST) and extensile lateral (EL) approaches in Sanders type 3 and 4 fractures, with postoperative hindfoot alignment as the primary outcome. METHODS: This retrospective comparative study included 74 patients treated between January 2017 and June 2023 using either the EL (n = 36) or ST (n = 38) approach. Radiographic evaluation included hindfoot alignment angle, calcaneal width, and Böhler and Gissane angles. Clinical outcomes were assessed using the AOFAS score and VAS. RESULTS: Mean follow-up was 40.8 ± 12.4 months. Postoperative hindfoot alignment did not differ significantly between groups (p = 0.25). No significant between-group differences were observed in radiographic parameters or clinical outcomes (all p > 0.05). CONCLUSION: The sinus tarsi approach achieved postoperative alignment, radiographic restoration, and clinical outcomes comparable to those of the extensile lateral approach.