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Displaced Intra-articular Calcaneal Fracture: Open Reduction and Internal Fixation

March 15, 2015

Contributors: Mark Gage, MD; Alan Wayne W. McGee, Jr, MD, BS; Dylan Lowe, MD; William Ryan, BS; Kenneth A Egol, MD, FAAOS; Kenneth A Egol, MD, FAAOS

RESULTS: This video demonstrates successful open reduction and internal fixation of an intrarticular calcaneal fracture. Final intraoperative radiographs demonstrate reduction of the fracture and implant placement. There is restoration of Bohler's and Gissanes's angles as well as reduction of injury heel varus, heel height, and width. Using judicious soft tissue technique and standard operative protocol principles lead to excellent clinical and function results.

CONCLUSION: Open reduction and internal fixation using a lateral approach for intrarticular calcanal fraction fractures allows successful fracture fixation, confirmed by radiographic imaging and restoration of calcaneal anatomy. Clinical outcomes from the orthopaedic literature regarding this technique demonstrate adequate reduction of the joint and improved outcomes.

BACKGROUND: Calcaneal fractures are the most common tarsal fractures, and approximately 75% are intra-articular in nature. Comminuted displaced fractures, male sex, and heavy manual labor are associated with poor outcomes. The optimal management of displaced intra-articular calcaneal fractures remains a matter of debate despite advancements in diagnosis by means of imaging and in surgical techniques. The popular treatment has turned toward operative intervention as recent literature has reported better radiographic and functional results with open reduction and restoration of calcaneal anatomy.

METHODS: This video presents the relevant concepts and surgical technique of open reduction and fixation of a Sanders Type II displaced intra-articular calcaneus fracture with lateral plating. Relevant patient history, injury presentation and workup, indications for surgery, imaging, postoperative rehabilitation, and clinical outcomes are presented. The important features of the technique are highlighted and the rationale behind the approach is reviewed.

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