Surgical Discussion

Patient positioning:  The patient was positioned supine with the affected limb elevated and supported to allow for optimal access and manipulation during reduction.

Anatomical surgical approach:  A stab incision was made distal to the fibula, allowing for the insertion of a freer elevator to disimpact the calcaneus. A spike pusher was then utilized for further reduction, followed by pinning to maintain alignment. After one week of soft tissue rest, a lateral extensile approach was employed for definitive open reduction and internal fixation (ORIF).

The initial reduction required careful percutaneous manipulation due to the calcaneus being firmly lodged. The use of a freer elevator as a shoehorn facilitated disimpaction, while a spike pusher assisted in achieving further reduction. Pinning maintained the reduction until definitive ORIF could be performed. The lateral extensile approach allowed for restoration of calcaneal morphology and articular congruity, with attention to preserving the soft tissue envelope.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing for several weeks, followed by gradual weight-bearing as tolerated, with emphasis on range of motion exercises to restore function.

Follow up:   Not specified.

Orthopaedic implants used:   Delta frame, freer elevator, spike pusher, pins for temporary fixation.