Lateral Approach to the CalcaneusThe lateral approach to the calcaneus is primarily used for open reduction and internal fixation of calcaneal fractures. Such fractures are always associated with significant soft-tissue swelling; it is critical to allow this soft-tissue swelling to subside before surgery is carried out to reduce the risk of skin necrosis. An accurate assessment of the vascular status of the patient is critical before undertaking surgery. Diabetes, especially with associated neuropathy and smoking, are relative contraindications to this surgery approach. The indications for the surgical approach include the following:
Open reduction and internal fixation of displaced calcaneal fractures
Treatment of other lesions of the posterior facet of the subtalar joint and lateral wall of the os calcis
Position of the Patient
Place the patient in the lateral position on the operating table. Ensure that the bony prominences are well padded. Place the leg that is to be operated on posteriorly with the under leg anterior. Exsanguinate the limb either by elevating it for 3 to 5 minutes or by applying a soft rubber bandage. Inflate a tourniquet.
Landmarks and Incision
Landmarks
Palpate the posterior border of the distal fibula and the lateral border of the Achilles tendon. Next, identify the styloid process at the base of the fifth metatarsal bone, which is easily felt along the lateral aspect of the foot.
Incision
The skin incision has two limbs. Begin the distal limb of the incision at the base of the fifth metatarsal and extend it posteriorly, following the junction between the smooth skin of the dorsum of the foot and the wrinkled skin of the sole. Make a second incision beginning approximately 6 to 8 cm above the skin of the heel, halfway between the posterior aspect of the fibula and the lateral aspect of the Achilles tendon. Extend this second incision distally to meet the first incision overlying the lateral aspect of the os calcis (Fig. 18-1).
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