title: 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.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Texas Tech Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX USA.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Rawicki
authors.affiliation: Texas Tech Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Wyatt
authors.affiliation: Texas Tech Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kusnezov
authors.affiliation: Texas Tech Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX USA.
authors.forename: Enes
authors.initials: E
authors.lastname: Kanlic
authors.affiliation: Texas Tech Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Abdelgawad
keywords: Sinus tarsi; calcaneus fracture; complication; deep infection; intra-articular; minimal invasive