Minimal invasive surgery of Fracture calcaneus
We will discuss how to fix the fracture calcaneus utilizing a minimally
invasive approach with K wires. From this x-ray you can see that there is a clear joint
depression type fracture with impaction
of the posterior facet. It is comminuted in
nature. CT is usually needed for closer
evaluation of this fracture.
The posterior facet is clearly broken in at least 2 or 3 pieces. It is important in this fracture reduction will be to identify these pieces and align them anatomically.
We can see from this lateral view the impaction of the posterior facet as well as loss of calcaneal inclination angle.
The first step of this minimally invasive approach is to identify the posterior aspect of the talus as well as the anterior aspect of the calcaneus.
The incision is created directly overlying the posterior facet angling anterior towards the anterior process of the calcaneus this can generally be performed through a 2.5 to 3 centimeter incision.
The peroneal tendons should be retracted inferiorly and the calcaneofibular ligament will need to be transected at this location.
We create an incision into the subtalar joint itself. We should always have a lamina spreader available so as to help reduction of the joint fragments. We use a cob type elevator to create a subperiosteal dissection path to see anatomical reduction.
We have identified these two posterior
fragment pieces and elevated them to an
anatomic alignment with a lamina
spreader.
Three millimeter K wires be placed from posterior to anterior.
For stabilization of posterior facet screws
may be needed to be placed at the very posterior aspect of the posterior facet. In these particular cases we utilize solid 4.0
millimeter bone screws from lateral to medial. We utilize a handheld measuring device to assure the correct length. These are generally approximately 35 to 40 millimeters inlength.
Laminate spreader is utilized to stabilize the position of bone fragments while fixation is being done.
Placing a bump underneath the ankle allows you to physically palpate when the screwdriver comes through the medial side of the calcaneus this must be done very carefully so as not to puncture a hole into your fingers.
The final outcome can be seen here that we've got a good alignment of the body of the calcaneus all joint surfaces were
adequately restored as well as the
calcaneal inclination angle and bowlers
angle.
Also note that the void within the
body of the calcaneus is clearly seen and this may need a bone graft.