Open Reduction and Internal Fixation of Intra-Articular Calcaneal Fractures Via an Extensile Lateral Approach.

Abstract

IntroductionAlthough 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 setupCoronal images are most helpful.Step 2 incision and soft-tissue managementElevate the flap using the "no-touch" technique to minimize wound complications.Step 3 reduce posterior facet and perform provisional stabilizationAchieve 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 plateUse a traditional nonlocking plate and be sure that at least one lag screw achieves purchase.Step 5 close woundUse the "no-touch" technique, with the goal of tension-free wound closure.Step 6 postoperative careWatch closely for drainage or delayed healing.Results & preop/postop imagesORIF is a viable treatment option for displaced intra-articular calcaneal fractures without contraindication for older patients.What to watch forIndicationsContraindicationsPitfalls & Challenges.