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Minimal invasive surgery of Fracture calcaneus

Minimal invasive surgery of Fracture calcaneus 

Intraoperative C Arm lateral view x ray view shows good reduction with K wires fixation of fracture calcaneus 
Lateral view x ray view shows fracture calcaneus with depression.

 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.

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