Minimally invasive treatment of Sanders type Ⅱ/Ⅲ fractures of the calcaneus using K-wire spreader combined with tarsal sinus approach

Zheng Chujian; Liang Yongcong; Zeng Lingling

doi:10.3969/j.issn.1009-4237.2026.01.005

Abstract：Objective To explore the application of K-wire spreader combined with tarsal sinus approach for minimally invasive internal fixation for Sanders typeIⅡ/Ⅲ fractures of the calcaneus.Methods A total of 104 patients with Sanders typeⅡ/Ⅲcalcaneal fractures treated at our hospital from during 2023 were selected.Accord-ing to the random number table method,patients were divided into a study group or a control group,with 52 cases in each group.The age range was 20-60 years,with an average of 50.0 years.There were 91 males and 13 females,with 49 cases of road traffic injuries,31 falls from heights,and 24 heavy object compression.Sanders classification defined 64 cases of type Ⅱ and 40 type Ⅲ,with 49 affecting the left side and 55 the right side.The control group received minimally invasive steel plate fixation through the tarsal sinus approach,while the study group used K-wire spreader to assist in fracture reduction based on the tarsal sinus approach.Surgical parameters,fracture healing time,X-ray results before surgery,3,6 and 12 months after surgery,as well as ankle joint function and complications at 12 months after surgery were compared between the two groups.Results The study group had a shorter surgical time and less frequency of X-ray fluoroscopy compared to the control group(P<0.05),but thefracture healing time-showed no statistically significant difference(P>0.05).Repeated measurement analysis of each group showed an increasing trend in Bohler angle and calcaneal height at 3,6,and 12 months postoperatively,and a decreasing trend of Gissane angle,calcaneal width and length(all P<0.05).At 3,6,and 12 months postoperatively,the Bohler an-gles in the study group were 23.26°±4.42°,31.24°±3.86°,and 31.66°±3.75°,respectively,which were higher than those in the control group(19.53°±3.85°,26.32°±4.17°,and 27.13°±4.16°).The Gissane angles were 131.53°±6.65 °,127.24°±4.54°,and 127.32°±4.62°,respectively,which were lower than those in the control group(137.36°±7.37°,132.42°±7.24°,and 131.84°±6.85°,P<0.05).The excellent rate of ankle joint function recovery in the study group was higher than that in the control group(P<0.05),but the calcaneus height,width,and length showed no statistically significant difference,nor did the incidence of complications(all P>0.05).Conclusion The use of K-wire spreader combined with tarsal sinus approach steel plate internal fixation for Sanders type Ⅱ/Ⅲ calcaneal fractures can shorten the surgical time,reduce X-ray fluoroscopy,promote the re-covery of Bohler angle and calcaneal height,and achieve a better ankle joint functional recovery.