Sinus Tarsi Approach for Calcaneal Fractures

Symptoms

• Pain

Physical examination

• Diffuse tenderness to palpation

• Ecchymosis and swelling

• Shortened, widened heel with a varus deformity

Radiographs

• Required: lateral ( Fig. 39.1A ) and axial calcaneus ( Fig. 39.1B )

  

• Optional: Brodén view

  • Allows visualization of the posterior facet

  • Useful for evaluation of intraoperative reduction of the posterior facet

  • With ankle in neutral dorsiflexion, take x-rays at 40°, 30°, 20°, and 10° of internal rotation

• Optional: Harris view

  • Visualizes tuberosity fragment widening, shortening, and varus positioning

  • Place the foot in maximal dorsiflexion and angle the x-ray beam 45°

• Optional: anteroposterior ankle ( Fig. 39.1C )

  • Demonstrates lateral wall extrusion causing fibular impingement

• Findings

  • Reduced Böhler angle

  • Increased angle of Gissane

  • Calcaneal shortening

  • Varus tuberosity deformity

• Measurement

  • Böhler angle (normal is 20–40°)

    • Measured from lateral foot x-ray

    • Flattening (decreased angle) represents collapse of the posterior facet

    • Double density highlights subtalar incongruity

    • Angle of Gissane (normal is 130–145°)

    • An increase represents collapse of the posterior facet

Computed tomography

• Gold standard

• Views

  • 30° semicoronal ( Fig. 39.2A )

    • Demonstrates posterior and middle facet displacement

    

  • Axial

    • Demonstrates calcaneocuboid joint involvement ( Fig. 39.2B )

  • Sagittal

    • Demonstrates tuberosity displacement ( Fig. 39.2C )

Magnetic resonance imaging

• Used only to diagnose calcaneal stress fractures in the presence of normal radiographs and/or uncertain diagnosis