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21 Jul 2025
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Complete Posterior Facet Dislocation of the Calcaneus with Medial Wall Displacement.

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Clinical Details

Clinical and radiological findings:  A 31-year-old male sustained a fall from a height of 30 feet while climbing, resulting in a closed calcaneal fracture with medial blistering. The posterior tibial nerve was functioning but compromised. The patient also presented with a segmental fibular fracture and a femoral shaft fracture. No injuries to the spine, chest, or head were noted. Radiological assessment, including X-rays and CT scans, revealed a complete dislocation of the posterior facet of the calcaneus through the medial wall.

Preoperative Plan

Planning remarks:  The preoperative plan involved immediate reduction of the posterior facet to prevent skin necrosis. A medial external fixator was planned to distract and recreate length and height, allowing for reduction of the posterior facet. Percutaneous localization with a wire was planned, followed by reduction using instruments such as a joker, freer, or pusher.

Surgical Discussion

Patient positioning:  Supine position with the affected limb elevated and supported to facilitate access to the medial aspect of the calcaneus.

Anatomical surgical approach:  A percutaneous approach was utilized for the reduction of the posterior facet. A wire was used for localization, followed by a small incision to allow for manipulation of the facet using blunt instruments. The reduction was secured with wiring, avoiding penetration through lateral skin structures.

Operative remarks: 

The surgeon emphasized the urgency of reducing the posterior facet to prevent skin necrosis and potential amputation. The use of a medial external fixator was crucial in creating space for reduction by distracting and elevating the talus. Post-reduction CT confirmed improved alignment, although further interventions were anticipated.

Postoperative protocol:   Initial immobilization with a medial external fixator, followed by gradual weight-bearing as tolerated. Close monitoring of skin integrity and neurovascular status was advised.

Follow up:   Not specified.

Orthopaedic implants used:   Medial external fixator, percutaneous wires for reduction stabilization.

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