Open Reduction and Internal Fixation of Intra-Articular Calcaneal Fractures Via an Extensile Lateral Approach by Karl M. Schweitzer, Trevor R. Gaskill,

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Open Reduction and Internal Fixation of Intra-Articular Calcaneal Fractures Via an Extensile Lateral Approach by Karl M. Schweitzer, Trevor R. Gaskill, Mark E. Easley, and James A. Nunley JBJS Essent Surg Tech Volume 1(2):e7 July 20, 2011 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Preoperative lateral hindfoot radiograph of a patient with a displaced intra-articular calcaneal fracture. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Preoperative oblique foot radiograph of a patient with a displaced intra-articular calcaneal fracture. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Preoperative sagittal CT of a patient with a displaced intra-articular calcaneal fracture. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Preoperative axial CT of a patient with a displaced intra-articular calcaneal fracture. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Preoperative coronal CT of a patient with a displaced intra-articular calcaneal fracture. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

A patient in the lateral decubitus position on a beanbag prior to ORIF of the calcaneus. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

A standard incision used to perform an extensile lateral approach to the calcaneus is marked. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative image demonstrating the “no-touch” technique with in (1.6-mm) Kirschner wires placed within the fibula, talar neck, and cuboid to retract a full-thickness soft-tissue flap. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Removal of the thin lateral calcaneal wall with forceps. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Elevation of the posterior facet with derotation of the depressed osseous fragments out of the calcaneal body. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Obtaining provisional Kirschner wire fixation after the initial reduction has been achieved. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Harris axial heel fluoroscopic views demonstrating inadequate restoration of hindfoot alignment with varus malreduction of the medial calcenal wall and tuberosity. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The restored alignment is confirmed clinically. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The restored alignment is confirmed radiographically. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Replacement of the lateral calcaneal wall fragment, which can be used as a “key” to ensure proper reduction and restoration of calcaneal height. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Provisional fixation and placement of a multi-hole calcaneal plate. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Radiographic confirmation of the appropriate position of the multi-hole calcaneal plate. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

In this case, the sustentacular lag screw is placed through the lateral plate. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Subsequent screws are placed into the subchondral bone under the articular surface as well as into the anterior process and the tuberosity. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Final lateral fluoroscopic view obtained to confirm maintenance of reduction and appropriate screw and plate position. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Peroneal tendon reduction after inspection of the subfibular recess and the posterior fibular groove. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Closure of the subcuticular layer toward the apex of the incision with a 4-0 absorbable suture. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Wound closure is completed with a 4-0 nonabsorbable monofilament suture with use of a modified Allgöwer-Donati technique. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Weight-bearing anteroposterior radiograph obtained at six months postoperatively demonstrating reduction of the posterior facet and medial calcaneal wall, along with maintenance of the Bohler angle and hindfoot alignment. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Weight-bearing lateral radiograph obtained at six months postoperatively demonstrating reduction of the posterior facet and medial calcaneal wall, along with maintenance of the Bohler angle and hindfoot alignment. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Weight-bearing Broden axial heel view obtained at six months postoperatively demonstrating reduction of the posterior facet and medial calcaneal wall, along with maintenance of the Bohler angle and hindfoot alignment. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Weight-bearing Harris axial heel view obtained at six months postoperatively demonstrating reduction of the posterior facet and medial calcaneal wall, along with maintenance of the Bohler angle and hindfoot alignment. Karl M. Schweitzer, Jr. et al. JBJS Essent Surg Tech 2011;1:e7 ©2011 by The Journal of Bone and Joint Surgery, Inc.