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. 2023 Jun;44(6):565-573.
doi: 10.1177/10711007231165765. Epub 2023 Apr 25.

A Stepwise Minimally Invasive Sinus Tarsi Approach to Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: Technique Tip

Johnny Rayes  1 , Paul Sharplin  1 , Peter Maalouf  2 , Scott Willms  1 , Andrew Dodd  1
Affiliations

A Stepwise Minimally Invasive Sinus Tarsi Approach to Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: Technique Tip

Johnny Rayes et al. Foot Ankle Int. 2023 Jun.
No abstract available

Keywords: calcaneus fracture; internal fixation; open reduction; sinus tarsi approach.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
Patient positioning and C-arm intensifier setup. (A) The patient is placed in the lateral decubitus position with the operative side (left) up. (B) A bump is placed under the foot to elevate it and make it horizontal. The C-arm intensifier is positioned obliquely in order to obtain a (C) true lateral view as well as a (D) calcaneal axial view.
Figure 2.
Figure 2.
Superior views of a left foot. (A) Skin landmarks and incision. (B) Lateral wall blunt dissection. Careful dissection of the lateral wall as well as both proximal and distal edges of the calcaneal tuberosity in preparation for plate positioning. It is important to dissect proximal to the peroneal tendons (*), as this will make inferior retraction easier.
Figure 3.
Figure 3.
Fluoroscopic views (A, lateral view; B, axial view) of a left foot displaced intra-articular calcaneal fracture showing medial wall reduction. Once the medial wall is elevated against the talar chondral facet, a 1.6-mm Kirschner wire is used to pin it in place through a transtalar trajectory started from the superolateral talar cortex. A Howarth elevator was used in this case for reduction.
Figure 4.
Figure 4.
Fluoroscopic views (A, axial view; B, lateral view) of a left foot displaced intra-articular calcaneal fracture showing calcaneal tuberosity reduction. Two 1.6-mm Kirschner wires are used to fix the calcaneal tuberosity to the previously fixed medial wall. The axial view is used first to guide the wire trajectory, followed by the lateral view, which confirms the divergent pattern for a stable reduction. The fluoroscopic views used to illustrate this step and the following steps are taken from a separate operative case.
Figure 5.
Figure 5.
Subtalar joint reduction of a left foot displaced intra-articular calcaneal fracture. (A) Intraoperative superior view after retraction of the peroneal tendons (*). The calcaneal facet (C) is elevated against the talar facet (T) and pinned to the medial calcaneal part. (B, C) Fluoroscopic views (B, lateral view; C, axial view) confirming joint reduction. One or two 2.7-mm lag screws can be used for fixation. A cannulated design was used in this case. The lateral view (B) is important to confirm subtalar joint reduction and the axial view (C) to confirm the screw length.
Figure 6.
Figure 6.
Intraoperative superior view of the subtalar joint of a left foot displaced intra-articular calcaneal fracture after retraction of the peroneal tendons (*). The plate is buttressing the lateral wall of the calcaneus (C), with its middle part overlying the lag screw. The white dashed line indicates the stab wound incision used first to introduce the transcalcaneal reduction pin, and second to insert the screws targeting the calcaneal tuberosity.
Figure 7.
Figure 7.
Fluoroscopic views (A, B, lateral views; C, axial view) of a left foot displaced intra-articular calcaneal fracture showing internal fixation with a calcaneal locking plate. (A) Correct plate positioning is confirmed with a lateral view, and a temporary wire fixing the anterior end of the plate allows fine control of the plate position prior to insertion of the first compression screw. Anatomic reduction is achieved with restored calcaneal height and subtalar joint (B), as well as a restored calcaneal axis (C).
Figure 8.
Figure 8.
Postoperative radiographic views. A, lateral; B, axial.
See this image and copyright information in PMC

References

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