Extended Lateral L-Shaped Approach
The L-shaped incision used in the extended lateral approach to the calcaneus is called the "extended lateral L-shaped approach" or "extended L-shaped lateral approach." This is the standard terminology used in orthopedic trauma surgery for accessing displaced intra-articular calcaneal fractures 1, 2, 3.
Surgical Context
This approach has been the traditional gold standard for open reduction and internal fixation (ORIF) of complex calcaneal fractures, particularly Sanders type II and III fractures. The incision provides:
- Extensive visualization of the lateral calcaneal wall
- Direct access to the subtalar joint for anatomic reduction
- Adequate exposure for plate fixation
Important Clinical Considerations
However, this approach carries significant wound complication risks. Multiple studies demonstrate concerning complication rates:
- Wound healing problems occur in 37.1% of cases with the extended L-shaped lateral approach 1
- Another study reported wound complications in 11.76% of cases using this traditional approach 4
- Complications include wound infection, hematoma, dehiscence, and sural nerve injury 5
Modern Alternative Approaches
The evidence strongly suggests that minimally invasive techniques through smaller incisions (such as the sinus tarsi approach) achieve equivalent functional outcomes with dramatically fewer complications:
- Wound complications reduced to 1.88-6.7% with minimally invasive approaches 1, 4
- Shorter operative times (52.5 vs 82.8 minutes) 1
- Reduced postoperative pain and hospital stay 1
- Comparable functional scores and radiographic outcomes 1, 3, 6
The extended lateral L-shaped approach remains relevant for complex fracture patterns requiring extensive exposure, but minimally invasive alternatives should be strongly considered when technically feasible to minimize morbidity while maintaining quality of reduction 3, 6.