What is the surgical procedure for a comminuted left calcaneal fracture with mild displacement, Sanders Type 4?

From the Guidelines

For a comminuted left calcaneal fracture with mild displacement of bone fragments (Type 4 according to Sanders classification), the recommended surgical procedure is Open Reduction Internal Fixation (ORIF) using a lateral approach, with the goal of achieving anatomical reduction and stable fixation to promote healing and minimize complications, as surgery is the usual treatment for such fractures 1.

The procedure typically involves:

• Administration of general anesthesia and prophylactic antibiotics (e.g., cefazolin 1g IV) 30 minutes prior to surgery
• A lateral approach to the calcaneus, with careful dissection and retraction of soft tissues to expose the fracture site
• Reduction of the fracture fragments using Kirschner wires, bone clamps, and other instruments to achieve anatomical alignment
• Fixation of the fracture using a calcaneal plate and screws, with or without the use of bone grafting to fill any defects
• Closure of the wound in layers, with a drain placed to prevent hematoma formation
• Postoperative management includes pain control with medications (e.g., acetaminophen 1000mg PO every 6 hours, oxycodone 10mg PO every 4 hours), elevation of the affected limb, and early mobilization to prevent stiffness and promote recovery.

It is essential to note that the specific surgical technique and fixation method may vary depending on the individual patient's anatomy, fracture pattern, and surgeon's preference. However, for minimally displaced fractures, simple immobilization may be considered as an alternative treatment option, although this is not typically recommended for comminuted fractures with mild displacement 1.

From the Research

Surgical Procedure for Comminuted Left Calcaneal Fracture with Mild Displacement, Sanders Type 4

The surgical procedure for a comminuted left calcaneal fracture with mild displacement, Sanders Type 4, can be approached through various methods, including:

• Open reduction and internal fixation (ORIF) using a calcaneal locking compression plate from an extended lateral approach 2
• Minimally invasive reduction and fixation (MIRF) using threaded K wires and Steinmann pins 3
• Modified Essex-Lopresti procedure with percutaneous calcaneoplasty using injectable calcium sulfate cement 4
• Indirect closed reduction and Kirschner wire or screw-assisted minimally invasive percutaneous osteosynthesis methods 5

Considerations for Surgical Approach

The choice of surgical approach depends on various factors, including:

• The severity of the fracture and the degree of displacement
• The presence of soft tissue complications or injuries
• The patient's overall health and medical history
• The surgeon's experience and preference

Medial Column Classification

Medial column classification can be used to guide the surgical selection for intra-articular fractures of the calcaneus, including Sanders Type 4 fractures 6. This classification system can help determine the best approach for surgical treatment and predict the outcome of the procedure.

Potential Complications and Risks

Potential complications and risks associated with surgical treatment of comminuted calcaneal fractures include:

• Wound complications, such as dehiscence or infection
• Nerve damage or impingement
• Malunion or nonunion of the fracture
• Postoperative pain or stiffness
• Limited mobility or function of the affected foot or ankle

Postoperative Care and Rehabilitation

Postoperative care and rehabilitation for comminuted calcaneal fractures typically involve:

• Immobilization of the affected foot or ankle for a period of time
• Pain management and medication
• Gradual mobilization and rehabilitation exercises to restore strength and function
• Follow-up appointments with the surgeon to monitor healing and progress 4, 3, 2