Calcaneus Fractures
Afshin A. Anoushiravani
Instruments and Equipment
Beanbag
Tourniquet
Large pointed bone reduction clamps (Weber clamps)
Laminar spreader
Dental picks and Freer elevators
Hintermann distractor
Hohmann retractor (small)
Rongeur (small)
Self-retaining retractor (small, sharp)
Senn-Miller retractors (17 cm)
Shoulder hook
Schanz pins (2.5-4.0 mm)
Femoral distractor (small)
Wire driver/drill with K-wires and appropriate drill bits
Implants
Mini- and small-fragment screws and mini-fragment plates (2.0/2.4/2.7/3.5 mm)
Calcaneal plates, locking or non-locking
Autograft, cancellous allograft, or other substitutes for bone defects
Patient Positioning
The patient is positioned in the lateral decubitus position (Figure 30-1).
Figure 30-1. Patient positioning—lateral decubitus. Reprinted from Pfeffer GB, Easley ME, Hintermann B, et al. Operative Techniques: Foot and Ankle Surgery. 2nd ed. Philadelphia, PA: Elsevier; 2018. Figure 39.4. Copyright © 2018 Elsevier. With permission.
The patient’s torso should be secured with a beanbag and the operative extremity supported on a well-padded bump of folded towels.
Special care is taken to pad all bony prominences, including the greater trochanter, fibular head, and elbow, thereby protecting the peroneal and radial nerves, respectively.
Indications and Contraindications for Surgical Intervention
Indications
Intra-articular calcaneal fractures with ≥2-mm step-off of the posterior facet
Intra-articular calcaneal fractures with Bohler angle <15° on lateral radiograph of the foot or ankle
Anterior process fractures with >25% involvement of the calcaneal-cuboid articulation
Displaced fractures of the calcaneal tuberosity
Fracture dislocations
Open calcaneal fractures
Contraindications
Severe peripheral vascular disease
Excessive swelling
Poorly controlled diabetes
Tobacco use
Noncompliant patient
Surgical Approach1
Operative treatment of closed fractures can be performed with an extensile lateral incision, a lateral incision over sinus tarsi, medial, or posterior incision allowing access to the various facets and regions of the calcaneus (Figure 30-2).
 Figure 30-2. Frequently fractured anatomic landmarks on calcaneus. Reprinted from Pfeffer GB, Easley ME, Hintermann B, et al. Operative Techniques: Foot and Ankle Surgery. 2nd ed. Philadelphia, PA: Elsevier; 2018. Figure 37.5. Copyright © 2018 Elsevier. With permission. |
Extensile Lateral Approach
Most common approach used for displaced intra-articular calcaneal fractures
Distal fibula and calcaneus are well outlined, as illustrated in Figure 30-3.
Must be careful near posterior and plantar outlines, calcaneocuboid joint, lateral neck, and sinus tarsi
The incision is marked at the level of the ankle joint, coursing just anterior to the Achilles tendon—if necessary, the distal aspect of the incision may be extended superiorly.
Once the incision is made, careful dissection of the proximal and distal aspects of the incision will avoid transection of the peroneal tendons and sural nerve.
Soft tissues are sharply removed with a scalpel or rongeur, providing adequate visualization of the fracture site.Related posts:
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Management of Lesser Toe Deformity: PIP Arthroplasty and Extensor Lengthening
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Talus Fractures
Fifth Metatarsal Stress Fractures
Arthroscopic Management of Osteochondral Lesions of the Talus
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