Question: In patients with Sanders type 2 calcaneal fractures, how do the sinus tarsi approach (STA) and extensile lateral approach (ELA) compare for wound complications? Design: Randomized (allocation concealed*), blinded (data collectors, data analysts, manuscript writers*), controlled trial with 12 months of follow-up. Setting: A clinical center in Korea. Patients: 64 patients.18 years of age (mean age, 50 years; 92% men) who had Sanders type 2A and 2B calcaneal fractures. Exclusion criteria were open or bilateral intra-articular calcaneal fractures or concomitant head or neurovascular injury. 100% of patients completed follow-up. Intervention: Patients were allocated to surgery using the STA (n = 32) or the ELA (n = 32). In the STA group, surgery was performed regardless of soft-tissue swelling and skin creases. In the ELA group, surgery was performed when soft-tissue swelling had subsided and skin creases were apparent. Main outcome measures: The primary outcome was wound complications, including minor (superficial infection and superficial marginal wound necrosis managed with small procedures, including irrigation, debridement, and additional suture, but not requiring reoperation) and major (deep infection and marginal wound necrosis involving implants and bones and requiring reoperation) complications. Secondary outcomes included sural nerve injury, checkrein deformity, pain (visual analog scale [VAS]: 0 = no pain to 10 = worst imaginable pain), pain and function (American Orthopaedic Foot & Ankle Society [AOFAS] score, with low numbers indicating a better outcome), quality of life (36-item Short Form health survey [SF-36]), and subtalar joint range of movement. Main results: Results for wound complications are in Table I. Mean operative duration was shorter in the STA group than in the ELA group (77 versus 118 minutes, p, 0.001). The STA group had less pain (mean VAS score, 3.8 versus 4.6, p = 0.017) and higher AOFAS scores (mean, 86.8 versus 82.3, p = 0.021) at 6 months; groups did not differ for pain, AOFAS scores, or SF-36 scores at 12 months (all p degrees 0.096). Subtalar joint range of motion was greater in the STA group than the ELA group (34 degrees versus 28 degrees, p = 0.015). Conclusion: In patients with Sanders type 2 calcaneal fractures, the STA resulted in fewer wound complications
