Calcaneal Fracture MIS treatment

1. DR.VAIBHAV GANDHI
M.S. [ ORTHO ]
VEETARAG HOSPITAL, AKLUJ.Maharashtra, India, 413101
Calcaneus Fractures -- MIS

2. I.A # CALCANEUM
ENIGMA

5. Calcaneus Fractures
 2 % of # in Young Adults
 Most common of all tarsal bone fractures – 60 %
 Very challenging injuries
 Wide variety of fracture patterns
Once considered “ in-operable ”
 New surgical technique,
 CT has made intervention more beneficial

9. Wide variety of fracture patterns

10. • Essex Lopresti
• A.O.
• Sandders [ C.T. Based ]

14. • 70% of all calcaneus fractures
• Usually fall from height
• Heel everted at time of injury
• Massive swelling
• Compartment syndromes in 10 %
• Skin complications
• 50% have associated injuries
• T&L Spine in 10%, bilateral 5%,
• open # 5%, # neck femur
Calcaneus Fractures: Intra-articular

15. Treatment Objectives
Re- Establish the height of the Calcaneum
Reduce the widening of the bone
Reduce the lateral & planter protrusions
of the bone
Re-establish the axis of posterior
fragment in frontal plane
Near anatomical reduction of the joint

16. MainGoal
Minimize the
possibility of
secondary problems

17. • Calcaneus fractures often
results in a varus deformity
of the heel
• Heel widening,
• Loss of calcaneal height,
• Subtalar joint incongruency
• Peroneal Impingment , Pain
Conservative Line of Treatment

19. CalcaneusFractures: Treatment
 Timing of surgery
 Positive “wrinkle test”
 Edematous skin heals poorly
 ORIF within first 24 hrs
 Or wait 1-3 weeks

20. ORIF of a calcaneus fracture is made
difficult by the complex anatomy, the
presence of soft cancellous bone (which
is not amenable to many screw fixation),
and the high incidence of postoperative
wound infection and skin breakdown.

24. M I S
 Close reduction with percutaneous fixation has
a lower risk of wound complications, a shorter
operative time, and more rapid healing because
the soft tissue is handled less.
 This approach is good in patient with significant
co-morbidity, soft tissue compromise &
polytrauma cases also.
 The goals of this approach include improvement
of heel alignment and reduction of the posterior
facet.

25. Surgical Technique
 The patient is placed in Supine Position on
the Radiolucent OT table under suitable
anaesthesia without tournqiet .
 To achieve correct placement / reduction; the
surgeon holds the heel of the patient with both
hands and applies compression both medially
and laterally with his thenar muscle to reduce
the Broadening & manually correct the heel
varus

27. Surgical Technique
 A Steinmann pin [ small bone spike] is put
into the dorso-lateral calcaneus beneath the
posterior facet with a stab incision on Lat.
wall skin Joystick manipulation done to
elevate the post. Facet.
 With the use of the X-ray image intensifier,
the restoration of Böhler’s angle and the
reduction of the posterior facet is verified.

29. Surgical Technique
 The fragments are fixed with percutaneus
Kirschner wires. All of the main fragments to be
reduced are hold in place by the K wires .
During this step , forefoot is flexed Planter wards
 The wires are bent above the skin level . OR
 One 6.5 mm Cann. Canc. Screw in sagittal plane
from Post. Tuberosity Postero- Superior to
Antero- Inf. planter direction , supporting the
crucial post & middle articular facet and one
horizontal screw in coronal plane from Sust. Tali
to lateral wall , in anteromedial to posterolateral
direction.

38. case 1 - 46 yrs / male

39. case 1 - 46 yrs / male

40. A-Y46/Male

48. 30yrs / male

53. 52yrs/male

55. MIS

63. 28yrs Male,open#

64. P-S 30/Male,open#

65. Calcaneus Fractures
 Complications
 Gravity related swelling
 Skin and wound healing problems
 Compartment syndrome
 Sural N. injury
 Infection / COM
 Malunion / Subtalar Arthritis
 Chronic Heel Pain.
 Peroneal Impingement.

66. M.I. S. RESULTS
 Close reduction with percutaneous fixation has a
lower risk of wound complications, a shorter
operative time, and more rapid healing because the
soft tissue is handled less.
 This approach is good in patients with significant
co-morbidity, soft tissue compromise & polytrauma .
 The goals of this approach include improvement of
heel alignment and reduction of the posterior facet.
prevention of broadening of calcaneus & restoration
of height of calcaneus.

67. THANK YOU