Surgical Discussion

Patient positioning:  The patient was positioned in a lateral decubitus position to facilitate access to the lateral aspect of the calcaneus during the surgical procedure.

Anatomical surgical approach:  An extensile lateral approach was utilized. A lateral L-shaped incision was made, extending from the posterior aspect of the heel to the sinus tarsi, allowing for full-thickness flap elevation. The lateral wall blowout and free posterior facet fragments were removed, marked, and placed in bacitracin solution. The anterior process was reduced and temporarily fixed with wires. The tuberosity was distracted and displaced posteriorly and medially to facilitate reduction of the anterior process to the constant fragment. The middle facet was reduced first, followed by the posterior facet fragments. The tuberosity was then repositioned anatomically, and the lateral wall was flattened and replaced to confirm reduction.

The surgeon emphasized the importance of restoring the normal relationship between the anterior process and the constant fragment at the critical angle to ensure room for an anatomical reduction of the posterior facet. The staged approach with initial external fixation facilitated soft tissue recovery and simplified subsequent ORIF by achieving early morphological restoration of the calcaneus.

Postoperative protocol:   Postoperatively, the patient was advised to remain non-weight bearing on the affected limb for 6 weeks, followed by gradual weight-bearing as tolerated. Range of motion exercises were initiated early to prevent stiffness, with progressive strengthening exercises introduced as healing permitted.

Follow up:   Not specified.

Orthopaedic implants used:   External fixator, Kirschner wires, calcaneal plate and screws.