To compare the clinical efficacy of tarsal sinus approach and lateral L-shape approach in the treatment of Sanders type Ⅲ calcaneal fracture.

A retrospective cohort study was used to analyze 32 patients with Sanders type Ⅲ calcaneal fracture from January 2013-June 2016, Patients were divided into minimally invasive group or incision group, of which 17 cases in the minimally invasive group used tarsal sinus approach and 15 cases in the incision group used lateral widened "L" approach, The general data of the two groups, the time from injury to surgery, operation time, postoperative drainage, Böhler angle and Gissane angle before and after surgery, postoperative complications, and the ankle-hind foot score of the American orthopaedic foot and ankle society (AOFAS) were recorded, and the results were compared.

All included patients were followed, and the mean follow-up time in the minimally invasive group and the incision group was (18.3±2.6) months and (19.6±3.3) months, respectively, and there was no statistically significant difference between the two groups (P>0.05). At the last follow-up visit, the AOFAS score in the minimally invasive group was (88.2±8.5) and the incision group was (87.4±11.2), and there was no significant difference between the two groups (P>0.05), and 1 case in the minimally invasive group and 3 cases in the incision group developed different degrees of subtalar arthritis. There was no significant comparison between the two groups (P>0.05). Analysis of variance by repeated measurement design of incisional group and minimally invasive group of Böhler angle, There was no significant difference between different groups (F=0.010, P=0.921), there was significant difference between different time points (F=92.201, P=0.000), and there was no interaction between groups and time points (F=0.166, P=0.848). Analysis of variance by repeated measurement design of incisional and minimally invasive groups of Gissane angles, There was no significant difference between different groups (F=0.012, P=0.912), there was significant difference between different time points (F=88.800, P=0.000), and there was no interaction between groups and time points (F=0.500, P=0.060). The Gissane angle of Böhler's angle was significantly improved in the minimally invasive group and the incision group at the last follow-up 1 day after surgery compared with the preoperative Gissane Angle, and the differences were statistically significant (P<0.05). The postoperative drainage was (30.5±19.3) ml in the minimally invasive group and (150.4±41.2) ml in the incisional group, the two groups were statistically significant (P<0.05). And one patient in the minimally invasive group had difficulty in repositioning the ankle by extending 2-3 cm from under the tip of the outer ankle to the posterior lower arc, the incision complications of the two groups were statistically significant (P<0.05).

No significant was found between the two groups in imaging restoration and functional recovery for Sanders type Ⅲ calcaneal fracture, but minimal invasive can significantly reduce early complications after operation.