Lateral approaches to the heel A comparison of two incisions for the fixation of calcaneal fractures

Abstract

Lateral approaches to the heel have been associated with poor soft tissue healing and sural nerve damage. We have compared the modified Kocher or direct lateral incision with the extended lateral incision for the open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. There were 20 patients in each group and the study confirmed that the extended lateral incision was associated with significantly less wound healing problems ( P < 0.01) and sural nerve problems ( P < 0.01) than the direct lateral incision. The extended lateral approach requires the more extensive dissection but no cases of wound infection or major nerve damage occurred in this group. Visualization of the subtalar joint was satisfactory and exposure of the fracture fragments for reduction and fixation of the fracture was excellent. We conclude that it is the preferred approach for calcaneal fracture fixation.