Abstract: Objective  To investigate the clinical effect of reduction and plate fixation via the sinus tarsi approach and L-shaped incision reduction and internal fixation in the treatment of calcaneal fractures. 
Methods  The clinical data of 96 patients with calcaneal fractures were selected for a retrospective study. According to different treatment plans, they were divided into tarsi sinus group and L-shaped group, with 48 cases in each group. The tarsal sinus group was treated with reduction and plate fixation via the tarsal sinus approach, and the L-shaped group was treated with L-shaped incision reduction and internal fixation. Surgical condition, postoperative recovery, excellent and good rate of surgery, and the incidence of complications were compared between two groups. Serum traumatic stress-inflammatory indexes［superoxide dismutase (SOD), malonaldehyde (MDA), tumor necrosis factor-α (TNF-α)］, transforming growth factor-β (TGF-β)/bone morphogenetic proteins(BMPs) signaling pathway indicators (TGF-β1, BMP-2, BMP-7) before and after surgery were compared between two groups. 
Results  The duration of operation, length of hospital stay, and fracture healing time were shorter in the tarsal sinus group than in the L-shaped group, and the intraoperative bleeding, intraoperative fluoroscopy, and postoperative drainage were less than those in the L-shaped group (P＜0.05). With the prolongation of treatment time, the serum SOD level of the two groups showed a trend of decreasing and then increasing, while the MDA and TNF-α levels showed a trend of increasing and then decreasing. The fluctuation of the tarsal sinus group was smaller than that of the L-shaped group, and the differences of interaction between groups, time points and time point between groups were statistically significant (P＜0.05). The serum TGF-β1, BMP-2, and BMP-7 levels in the two groups showed a gradual increase, and the serum TGF-β1, BMP-2, and BMP-7 levels in the tarsal sinus group were higher than those in the L-shaped group (P＜0.05). The difference in the excellent and good rate of surgery between two groups was not statistically significant (P＞0.05). The overall complication rate was lower in the tarsal sinus group than in the L-shaped group (P＜0.05).  
Conclusion  Compared with L-shaped incision reduction and internal fixation, reduction and plate fixation via the sinus tarsi approach in the treatment of calcaneal fractures can reduce surgical trauma, shorten the duration of operation, reduce stress and inflammation reactions caused by surgical trauma, reduce the incidence of complications, further improve the expression level of TGF-β/BMPs signaling pathway indexes in patients, and promote postoperative recovery, which is of higher application value in clinical practice.

Key words: calcaneal, fracture, fracture fixation