Surgical Discussion

Patient positioning:  The patient was positioned prone on the operating table to facilitate access to the posterior aspect of the calcaneus.

Anatomical surgical approach:  A lateral approach to the calcaneus was performed. A longitudinal incision was made over the lateral aspect of the heel, extending from the posterior superior corner of the calcaneus towards the cuboid. The sural nerve was identified and protected. The peroneal tendons were retracted, and a subperiosteal dissection was carried out to expose the lateral wall of the calcaneus.

The surgeon noted that the skin blanching indicated an urgent need for reduction to prevent necrosis. A gastrocnemius recession was performed to aid in reduction. A 4.5mm Schanz pin was inserted along the long axis of the tongue fragment, allowing for manipulation and reduction of the fracture. The fragment was then pinned into the cuboid for stabilization. The plantar medial tuberosity fragment, which was large and displaced, was also fixed to restore calcaneal height and prevent biomechanical complications.

Postoperative protocol:   Postoperatively, the patient was placed in a splint with non-weight bearing status on the affected limb for 6 weeks. Progressive weight bearing was initiated thereafter, with physical therapy focusing on range of motion and strengthening exercises.

Follow up:   Not specified.

Orthopaedic implants used:   4.5mm Schanz pin, Kirschner wires for pinning into cuboid.