Introduction Although displaced intra-articular calcaneal fractures were historically treated nonoperatively because of unreliable outcomes, they are now commonly treated with open reduction and internal fixation (ORIF).
Step 1: Preoperative Planning and Operative SetupCoronal images are most helpful.
Step 2: Incision and Soft-Tissue ManagementElevate the flap using the “no-touch” technique to minimize wound complications.
Step 3: Reduce Posterior Facet and Perform Provisional StabilizationAchieve anatomic reduction of the medial calcaneal wall before proceeding with the remainder of the fracture reduction.
Step 4: Apply Lag Fixation and a Lateral Neutralization PlateUse a traditional nonlocking plate and be sure that at least one lag screw achieves purchase.
Step 5: Close WoundUse the “no-touch” technique, with the goal of tension-free wound closure.
Step 6: Postoperative CareWatch closely for drainage or delayed healing.
Results & Preop./Postop. Images ORIF is a viable treatment option for displaced intra-articular calcaneal fractures without contraindication for older patients.
What to Watch For Indications
Pitfalls & Challenges
Although displaced intra-articular calcaneal fractures were historically treated nonoperatively because of unreliable outcomes, they are now commonly treated with open reduction and internal fixation (ORIF)1,2. Recognition of the importance of anatomic reduction of the posterior facet, improved soft-tissue handling, use of intraoperative imaging, and implant improvements have contributed to this shift in management3-6. Ultimately, surgical or nonsurgical management should be individualized to each patient on the basis of a multitude of factors, including the status of the soft-tissue envelope, patient comorbidities (e.g., diabetes mellitus, cardiopulmonary disease, and vasculopathy), nicotine use, concurrent injuries, age, activity level, compliance, and fracture pattern.
Incisions to expose the fractured calcaneus include medial, lateral, combined medial and lateral, and extensile lateral approaches, with the lateral approach being most commonly used7-11. For certain …
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