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Case Reports
. 2023 May 20:46:100850.
doi: 10.1016/j.tcr.2023.100850. eCollection 2023 Aug.

Treatment of a compound calcaneus fracture Sanders IV with an external circular fixator and calcaneal osteotomy

Ofer Heinig  1 , Elia Feicht  1 , Assil Mahamid  2 , Roman Liberson  1 , Claude Picard  1 , Aharon Liberson  1
Affiliations
Case Reports

Treatment of a compound calcaneus fracture Sanders IV with an external circular fixator and calcaneal osteotomy

Ofer Heinig et al. Trauma Case Rep. .

Abstract

Compound Gustilo-type III intra-articular calcaneus fractures are challenging to treat. Anatomical reduction of the subtalar joint increases the chances of a better functional outcome and is traditionally achieved by an open reduction and plating. Conversely, ORIF is associated with a high risk of infection and even amputation. In our case study, we present the treatment of a Gustilo-type III intra-articular calcaneus fracture with a circular external fixator and a temporary antibiotic cement spacer for fracture reduction and stabilization. Active bio-glass was implanted to fill bone loss and to prevent infection. A closing-wedge calcaneal tuberosity osteotomy was used to facilitate wound closure. We paid special attention to reducing the posterior facet. The patient returned to work and full ambulation five months post-injury.

Keywords: Calcaneal fracture; Compound; External fixation; Ilizarov technique.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Medial hindfoot wound on presentation to ER.
Fig. 2
Fig. 2
AP + lateral ankle x-ray on presentation to ER.
Fig. 3
Fig. 3
Sagittal, Coronal and Axial CT-scan after initial splinting in ER.
Fig. 4
Fig. 4
External circular fixator.
Fig. 5
Fig. 5
Initial irrigation and debridement in OR.
Fig. 6
Fig. 6
Post-operative lateral x-ray.
Fig. 7
Fig. 7
Signs of skin necrosis over medial hindfoot.
Fig. 8
Fig. 8
Pre-surgical planning of calcaneal closing-wedge osteotomy with partial excision of the middle calcaneal tuberosity. The green area represents the excised fragment. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 9
Fig. 9
Post-operative coronal CT-slide showing the closing wedge calcaneal osteotomy.
Fig. 10
Fig. 10
Post-operative sagittal CT slide showing the hyperdense active glass that was used to fill the bone defect.
Fig. 11
Fig. 11
Cast with a modified Boehler attachment to allow for partial weight bearing and VAC treatment in preparation for skin graft.
Fig. 12
Fig. 12
Wound after VAC treatment in preparation for skin graft.
Fig. 13
Fig. 13
Five months post-injury lateral ankle x-ray.
See this image and copyright information in PMC

References

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