Open Reduction and Internal Fixation of Intra-Articular Calcaneal Fractures Via an Extensile Lateral Approach.
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2011-07
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Abstract
Introduction
Although displaced intra-articular calcaneal fractures were historically treated nonoperatively because of unreliable outcomes, they are now commonly treated with open reduction and internal fixation (ORIF).Step 1 preoperative planning and operative setup
Coronal images are most helpful.Step 2 incision and soft-tissue management
Elevate the flap using the "no-touch" technique to minimize wound complications.Step 3 reduce posterior facet and perform provisional stabilization
Achieve anatomic reduction of the medial calcaneal wall before proceeding with the remainder of the fracture reduction.Step 4 apply lag fixation and a lateral neutralization plate
Use a traditional nonlocking plate and be sure that at least one lag screw achieves purchase.Step 5 close wound
Use the "no-touch" technique, with the goal of tension-free wound closure.Step 6 postoperative care
Watch closely for drainage or delayed healing.Results & preop/postop images
ORIF is a viable treatment option for displaced intra-articular calcaneal fractures without contraindication for older patients.What to watch for
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Schweitzer, Karl M, Trevor R Gaskill, Mark E Easley and James A Nunley (2011). Open Reduction and Internal Fixation of Intra-Articular Calcaneal Fractures Via an Extensile Lateral Approach. JBJS essential surgical techniques, 1(2). p. e7. 10.2106/jbjs.st.k.00012 Retrieved from https://hdl.handle.net/10161/34709.
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Scholars@Duke
Karl Martin Schweitzer
My pursuit of a career in orthopaedics has come as no surprise to those around me. Growing up on our family horse farm in Mechanicsburg, Pa., afforded me many mechanical tasks. Foot and ankle orthopaedic surgery was an obvious choice: the diverse patient population, challenging surgeries, exciting research, and the ability to help my patients get back to the activities they enjoy most.
I do not take for granted my wonderful mentors throughout residency and fellowship training. I am thankful to be practicing back where my interest in foot and ankle was first ignited. My wife Samantha and I are excited to be back living in the Triangle.
As medical missionary, Dr. Albert Schweitzer said, “At times our own light goes out and is rekindled by the spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” It is my responsibility, but also privilege as a surgeon, to empower my patients with ‘that light’, through optimism, knowledge, and ultimately relief, through both non-operative and surgical means.
Mark Erik Easley
James Albert Nunley
My current research interests are both clinical and basic science. Currently, in the Orthopaedic Research Laboratory, we are investigating the biomechanical properties of the deltoid ligament in the ankle. This is a clinically relevant problem and we will hopefully identify ways to improve the correction of the adult relaxed flat foot. We are also performing a preliminary investigation into the blood supply of the distal tibia to look for a vascularized bone transfer.
We have recently completed a biomechanical study looking at the strength of fixation for proximal metatarsal osteotomies in the correction of hallux valgus and that information has been submitted for publication.
Clinical projects have looked into nerve palsies after total elbow replacement and to reconstructive upper and lower extremity surgery.
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