Case description

A 39-year-old man fell from a height of 7 m, sustaining polytrauma. He presented with severe soft-tissue swelling over the right calcaneus. Standard x-rays and a CT scan revealed a displaced, intraarticular calcaneal fracture (Sanders type III, AO/ICI type B2) with a severely dislocated “tongue” fragment that was exerting severe pressure on the skin and soft tissues from the inside.

Preoperative planning

Polytraumatized patients require a quick procedure. Reduction of the gross dislocation has to be achieved quickly by ligamentotaxis using external three-point distraction from the medial side. The cranially displaced tongue fragment has to be reduced immediately to prevent skin necrosis over the insertion of the Achilles tendon. Definitive ORIF via an extended lateral approach can then be planned precisely and carried out after improvement in both the soft tissues and the patient‘s overall condition.

Percutaneous reduction of the overall shape of the calcaneus via direct manipulation and ligamentotaxis prevents soft-tissue shrinkage and makes late ORIF easier in a patient who is in a critical condition. Medial pin placement does not interfere with a lateral approach for definitive fracture fixation.