Surgical treatment of displaced intra-articular os calcis fractures: The lateral approach

Abstract

The lateral approach to the displaced intra-articular os calcis fracture provides excellent visualization of the lateral wall, the calcaneocuboid joint, and the posterior facet, allowing direct restoration of calcaneus height and tuber alignment but requires indirect tuber-sustentaculum reduction. This approach permits operative restoration of calcaneal anatomy which, in the properly selected patients, is often superior to the nonoperative treatment of calcaneus fractures. In summary, the “L” or “reversed L” approach maintains the sural nerve in a full thickness flap which includes the subperiosteal elevation of the calcaneofibular ligament and peroneal tendons within the single flap. Excellent visualization allows reduction of the anterior process to the sustentacular fragment and then the crucial angle of Gissane. Reduction of the tuberosity is then followed by reduction of the posterior facet, and lastly, reduction of the lateral wall. Initial reduction is achieved with 0.045 and 0.054 K-wires and then confirmed with roentgenograms. Bone graft is used to fill any large cancellous defects before definitive plate fixation. Postoperatively, the patients are treated with early range of motion, non-weight-bearing for 10 to 12 weeks, and the hardware may be removed at approximately 1 year.