Case for small group discussion Calcaneal fracture Case for small group discussion AOTrauma—Foot & Ankle Module 2a: Hindfoot trauma—calcaneal fractures Hans Zwipp and Stefan Rammelt, DE

Case description 36-year-old man Motor vehicle accident Closed injury Severe ankle and hindfoot pain Abnormal contour of heel and malleolar region

Preoperative CT scans Day 0

Modified palmer approach McReynolds approach Day 9

Modified palmer approach for fracture dislocations—intraoperative images Fibula T SU TU TU: Tuberosity fragment SU: Sustentacular fragment PT Day 9

Postoperative x-rays Day 9

Postoperative x-rays

15-month follow-up Standing Standing

15-month follow-up

Take-home messages High index of suspicion Pattern recognition (double contour, direct fibular fracture) Direct lateral approach starting at the tip of the fibula to address both calcaneal fracture dislocation and peroneal tendon dislocation with fibular fracture if present Often two-part fracture within the posterior facet Compression screw fixation to the sustentaculum Antiglide plate fixation from medial References: Rammelt S, Zwipp H. Calcaneus fractures: facts, controversies and recent developments. Injury. 2004 May;35(5):443–461. Zwipp H, Rammelt S, Barthel S. Calcaneal fractures--open reduction and internal fixation (ORIF). Injury. 2004 Sep;Suppl:SB46–SB54. Rammelt et al. Injury. 2004;35:443–461. Zwipp et al. Injury. 2004;Suppl:SB46–SB54.