Abstract
The sinus tarsi approach has gained popularity for treating calcaneal fractures; however, limited research exists on the learning curve among novice orthopedic surgeons. This study aimed to assess the learning curve of junior orthopedic surgeons who have recently completed their fellowship, focusing on surgical efficiency and clinical outcomes. From October 2022 to January 2024, 50 cases of calcaneal fractures (12 Sanders type 2, 23 type 3, and 15 type 4) were treated using the sinus tarsi approach at a single Level 1 trauma center. The cumulative sum test was employed to identify case cutoffs for key surgical parameters. Pre- and postoperative X-rays and computed tomography (CT) were analyzed to measure the Bohler angle, hindfoot varus angle, and posterior facet step-off. Operative time, intraoperative C-arm fluoroscopy use, and postoperative complications, including infections and revision surgeries, were also evaluated. Significant postoperative improvements were observed: the Bohler angle increased from 12.2° to 26.3°, hindfoot varus angle decreased from 15.2° to 5.3°, and posterior facet step-off was reduced from 14.1 mm to 0.56 mm. Consistent correction of the Bohler angle and hindfoot varus angle was achieved after 21 cases, while posterior facet step-off correction reached proficiency after 26 cases. Reduction quality was classified as Excellent (n = 24), Good (n = 13), Fair (n = 8), and Poor (n = 5), with Excellent or Good outcomes achieved consistently after 21 cases. The mean operative time was 104 min, decreasing from 124.2 min to 85.2 min after 24 cases. The average number of fluoroscopy shots was 141, decreasing from 206.4 in the first 19 cases to 95.1 thereafter. Complications included six revision surgeries, one infection, four cases of insufficient posterior facet correction, and one case of screw penetration. Novice foot and ankle surgeons can achieve surgical proficiency in the sinus tarsi approach for calcaneal fracture fixation after approximately 20 to 26 cases. This learning curve was reflected by improved operative efficiency, reduced fluoroscopy use, and consistent radiographic correction of the Bohler angle, hindfoot varus angle, and posterior facet step-off.