From the Guidelines
A surgical calcaneus fracture is a severe break in the heel bone that requires surgical intervention, particularly for tongue-type calcaneus fractures which may need more urgent attention. This type of fracture typically occurs from high-energy trauma like falls from height or motor vehicle accidents, resulting in significant displacement of bone fragments or joint involvement that cannot be adequately treated with conservative methods 1. The decision to operate is influenced by the fracture pattern, with some fractures requiring urgent attention while others can wait up to 24 hours, allowing for better resource allocation and operating room preparation 1.
Key Considerations for Surgical Intervention
- The fracture involves the subtalar joint
- The fracture has multiple fragments
- The fracture shows significant displacement
- The patient's overall health and lifestyle factors
Surgical Approach and Goals
The standard surgical approach involves making an incision on the side of the heel, carefully repositioning the bone fragments to restore normal anatomy, and securing them with specialized plates and screws. The goal of surgery is to restore the height, width, and alignment of the calcaneus while preserving joint function 1.
Postoperative Care and Potential Complications
Recovery typically requires 8-12 weeks of limited weight-bearing followed by physical therapy, with full recovery taking 6-12 months. Potential complications include wound healing problems, infection, nerve damage, and post-traumatic arthritis, which is why surgical treatment is carefully considered based on fracture pattern, patient health, and lifestyle factors 1. The use of perioperative and postoperative systemic antibiotics, such as cefazolin or clindamycin, is recommended to prevent surgical site infections 1.
From the Research
Definition of Surgical Calcaneus Fracture
A surgical calcaneus fracture refers to a break in the calcaneus bone that requires surgical intervention to repair.
- The calcaneus bone is a critical structure in the foot, and fractures to this bone can be complex and challenging to treat 2, 3.
- Surgical treatment of calcaneus fractures typically involves open reduction and internal fixation (ORIF), which aims to restore the anatomy of the bone and promote healing 4, 5.
Surgical Approaches
There are different surgical approaches to treating calcaneus fractures, including:
- The extensile lateral approach, which offers advantages in achieving adequate fracture reduction but carries a risk of wound-healing complications and infection 4.
- The sinus tarsi approach, which is becoming a new gold standard for treating displaced intraarticular calcaneal fractures 5.
- Limited open reduction and internal fixation techniques, which focus on achieving fracture reduction with less risk of wound complications but may carry a higher risk of malunion 4.
Fixation Methods
Various fixation methods are used in the surgical treatment of calcaneus fractures, including:
- Lag screws and reconstruction plates 2.
- Anatomically shaped calcaneal plates, which have been available since the early 1990s 2, 3.
- Locking calcaneal plates, which have been shown to provide sound functional outcomes and restore anatomical reconstruction of the calcaneus bone 6.
Outcomes and Complications
The outcomes of surgical calcaneus fracture treatment can vary, with some studies reporting excellent to good results in a majority of patients 6.