Surgical Management of Calcaneal Fractures Using Bilateral Incisions and Minimal Internal Fixation

Nine patients with displaced calcaneal fractures were approached through bilateral incisions and stabilized with minimal internal fixation. All patients were men, with an average age of 35 years (range, 19-65). All fracture patterns had three-part split depression fractures of the posterior facet, a single intact sustentacular tali fragment, middle facet, and anterior body fractures. The reduction of tubercle impaction and varus angulation was accomplished by stabilization of the sustentacular tali-posterior tubercle fracture line through a modified medial vertical incision. Minimal fixation using either a three-prong staple or 4-mm lag screws was sufficient to stabilize this fracture pattern. Posterolateral facet articular elevation, and final reconstruction of Bohler's and Gissane's angles were performed through an extended lateral incision. Five of nine calcanei were stabilized with lag screws only and four required minimal lateral plate osteosynthesis. Preoperative Bohler's and Gissane's angles averaged 6 degrees and 138 degrees; postoperative angles averaged 34 degrees and 123 degrees, respectively. The average difference between postoperative Bohler's and Gissane's angles compared with the normal contralateral side was 1 degree each. There was no loss of reduction, and healing was uneventful. There was anatomic reconstruction of both medial and lateral cortexes in all cases. In this specific fracture pattern, medial stabilization of the sustentacular talitubercle fracture line can reduce both the amount and extent of lateral fixation, facilitate anatomic reduction of the posterior facet, and reduce postoperative implant sequelae after internal fixation.