Double-sided calcaneal fracture—AO/ICI type B1, Sanders type II
Case description
A 22-year-old man sustained bilateral calcaneal fractures when he fell from a height onto a concrete floor. CT scans were used for thorough fracture assessment. These revealed a Sanders type IIC fracture on the right side and a Sanders type IIB fracture on the left side. The other joints were not displaced, so these fractures are classified as AO/ICI type B1 fractures on both sides. Because of the intraarticular displacement on both sides, operative treatment was indicated.
Indication for MIPO
Minimally invasive plate osteosynthesis is indicated because of the simple facture pattern (Sanders type II) on both sides without deep impaction. The fragment size is large enough to make the case suitable for percutaneous reduction.
Preoperative planning
Both fractures can be successfully reduced percutaneously. On the right side the posterior facet of the subtalar joint is displaced in one piece (Sanders type IIC). Therefore, the joint can only be reduced under image intensifier control. The fracture on the left side has a step-off in the subtalar joint (Sanders type IIB). It therefore needs additional arthroscopic control to ensure that an anatomical joint reduction is achieved. The tuberosity fragment is reduced with the help of a Schanz screw ( Fig. 22.2-2 ). After temporary K-wire fixation and control of reduction, the main fragments are fixed percutaneously. 3.5 mm screws are used in this case because the patient is young with sufficient bone stock. In elderly patients with osteoporotic bone, 4.5 mm screws or a combination of 3.5 and 4.5 mm screws should be used.
Operating room setup
Anesthesia
General anesthesia is recommended for calcaneal fracture fixation because the lateral decubitus position usually is uncomfortable for the patient. Alternatively, spinal anaesthesia may be used.
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