SlideShare a Scribd company logo
1 of 67
DR.VAIBHAV GANDHI
M.S. [ ORTHO ]
VEETARAG HOSPITAL, AKLUJ.Maharashtra, India, 413101
Calcaneus Fractures -- MIS
I.A # CALCANEUM
ENIGMA
Calcaneus Fractures
 2 % of # in Young Adults
 Most common of all tarsal bone fractures – 60 %
 Very challenging injuries
 Wide variety of fracture patterns
Once considered “ in-operable ”
 New surgical technique,
 CT has made intervention more beneficial
Wide variety of fracture patterns
• Essex Lopresti
• A.O.
• Sandders [ C.T. Based ]
• 70% of all calcaneus fractures
• Usually fall from height
• Heel everted at time of injury
• Massive swelling
• Compartment syndromes in 10 %
• Skin complications
• 50% have associated injuries
• T&L Spine in 10%, bilateral 5%,
• open # 5%, # neck femur
Calcaneus Fractures: Intra-articular
Treatment Objectives
Re- Establish the height of the Calcaneum
Reduce the widening of the bone
Reduce the lateral & planter protrusions
of the bone
Re-establish the axis of posterior
fragment in frontal plane
Near anatomical reduction of the joint
MainGoal
Minimize the
possibility of
secondary problems
• Calcaneus fractures often
results in a varus deformity
of the heel
• Heel widening,
• Loss of calcaneal height,
• Subtalar joint incongruency
• Peroneal Impingment , Pain
Conservative Line of Treatment
CalcaneusFractures: Treatment
 Timing of surgery
 Positive “wrinkle test”
 Edematous skin heals poorly
 ORIF within first 24 hrs
 Or wait 1-3 weeks
ORIF of a calcaneus fracture is made
difficult by the complex anatomy, the
presence of soft cancellous bone (which
is not amenable to many screw fixation),
and the high incidence of postoperative
wound infection and skin breakdown.
M I S
 Close reduction with percutaneous fixation has
a lower risk of wound complications, a shorter
operative time, and more rapid healing because
the soft tissue is handled less.
 This approach is good in patient with significant
co-morbidity, soft tissue compromise &
polytrauma cases also.
 The goals of this approach include improvement
of heel alignment and reduction of the posterior
facet.
Surgical Technique
 The patient is placed in Supine Position on
the Radiolucent OT table under suitable
anaesthesia without tournqiet .
 To achieve correct placement / reduction; the
surgeon holds the heel of the patient with both
hands and applies compression both medially
and laterally with his thenar muscle to reduce
the Broadening & manually correct the heel
varus
Surgical Technique
 A Steinmann pin [ small bone spike] is put
into the dorso-lateral calcaneus beneath the
posterior facet with a stab incision on Lat.
wall skin Joystick manipulation done to
elevate the post. Facet.
 With the use of the X-ray image intensifier,
the restoration of Böhler’s angle and the
reduction of the posterior facet is verified.
Surgical Technique
 The fragments are fixed with percutaneus
Kirschner wires. All of the main fragments to be
reduced are hold in place by the K wires .
During this step , forefoot is flexed Planter wards
 The wires are bent above the skin level . OR
 One 6.5 mm Cann. Canc. Screw in sagittal plane
from Post. Tuberosity Postero- Superior to
Antero- Inf. planter direction , supporting the
crucial post & middle articular facet and one
horizontal screw in coronal plane from Sust. Tali
to lateral wall , in anteromedial to posterolateral
direction.
case 1 - 46 yrs / male
case 1 - 46 yrs / male
A-Y46/Male
30yrs / male
52yrs/male
MIS
28yrs Male,open#
P-S 30/Male,open#
Calcaneus Fractures
 Complications
 Gravity related swelling
 Skin and wound healing problems
 Compartment syndrome
 Sural N. injury
 Infection / COM
 Malunion / Subtalar Arthritis
 Chronic Heel Pain.
 Peroneal Impingement.
M.I. S. RESULTS
 Close reduction with percutaneous fixation has a
lower risk of wound complications, a shorter
operative time, and more rapid healing because the
soft tissue is handled less.
 This approach is good in patients with significant
co-morbidity, soft tissue compromise & polytrauma .
 The goals of this approach include improvement of
heel alignment and reduction of the posterior facet.
prevention of broadening of calcaneus & restoration
of height of calcaneus.
THANK YOU

More Related Content

What's hot

Calcaneal Fractures
Calcaneal FracturesCalcaneal Fractures
Calcaneal Fractures
Thanh Nguyen
 
calcaneal fractures by dr.waleed maher ali - minia university 2011
calcaneal fractures   by  dr.waleed maher ali - minia university 2011calcaneal fractures   by  dr.waleed maher ali - minia university 2011
calcaneal fractures by dr.waleed maher ali - minia university 2011
Waleed Ali
 
6 Calcaneum fracture
6 Calcaneum fracture6 Calcaneum fracture
6 Calcaneum fracture
drajun
 

What's hot (20)

Calcaneal fractures
Calcaneal fracturesCalcaneal fractures
Calcaneal fractures
 
Calcaneum fracture
Calcaneum fractureCalcaneum fracture
Calcaneum fracture
 
Calcaneum fractures
Calcaneum fracturesCalcaneum fractures
Calcaneum fractures
 
Calcaneal Fractures
Calcaneal FracturesCalcaneal Fractures
Calcaneal Fractures
 
calcaneal fractures by dr.waleed maher ali - minia university 2011
calcaneal fractures   by  dr.waleed maher ali - minia university 2011calcaneal fractures   by  dr.waleed maher ali - minia university 2011
calcaneal fractures by dr.waleed maher ali - minia university 2011
 
Calcaneus fracture
Calcaneus fractureCalcaneus fracture
Calcaneus fracture
 
6 Calcaneum fracture
6 Calcaneum fracture6 Calcaneum fracture
6 Calcaneum fracture
 
Talar fractures2
Talar fractures2Talar fractures2
Talar fractures2
 
Midshaft femur fracture
Midshaft femur fractureMidshaft femur fracture
Midshaft femur fracture
 
Talar Fracture
Talar FractureTalar Fracture
Talar Fracture
 
Distal radius malunion , correction
Distal radius malunion , correctionDistal radius malunion , correction
Distal radius malunion , correction
 
L14 talus fxs & dislocation
L14 talus fxs & dislocationL14 talus fxs & dislocation
L14 talus fxs & dislocation
 
Tibial plateau fractures
Tibial plateau fracturesTibial plateau fractures
Tibial plateau fractures
 
Overview conservative management of long bone fracture in adult
Overview conservative management of long bone fracture in adultOverview conservative management of long bone fracture in adult
Overview conservative management of long bone fracture in adult
 
Calcaneal fractures
Calcaneal fracturesCalcaneal fractures
Calcaneal fractures
 
Ortho Journal Club 7 by Dr Saumya Agarwal
Ortho Journal Club 7 by Dr Saumya AgarwalOrtho Journal Club 7 by Dr Saumya Agarwal
Ortho Journal Club 7 by Dr Saumya Agarwal
 
Wrist arthroplasty
Wrist arthroplastyWrist arthroplasty
Wrist arthroplasty
 
Radius and Ulna Shaft Fracture
Radius and Ulna Shaft  FractureRadius and Ulna Shaft  Fracture
Radius and Ulna Shaft Fracture
 
Forearm fracture, A Wednesday child in upper extremity fracture
Forearm fracture, A Wednesday child in upper extremity fractureForearm fracture, A Wednesday child in upper extremity fracture
Forearm fracture, A Wednesday child in upper extremity fracture
 
Pearls and pitfalls with im nailing of proximal tibia fractures
Pearls and pitfalls with im nailing of proximal tibia fracturesPearls and pitfalls with im nailing of proximal tibia fractures
Pearls and pitfalls with im nailing of proximal tibia fractures
 

Similar to I. a. # calc 2015 vaibhav gandhi

MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
MENISCUS REPAIR  I Dr.RAJAT JANGIR JAIPURMENISCUS REPAIR  I Dr.RAJAT JANGIR JAIPUR
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
Dr.RAJAT JANGIR Orthopaedic surgeon Jaipur
 
Clavicle fractures&acromio clavicular joint injuries
Clavicle fractures&acromio clavicular joint injuriesClavicle fractures&acromio clavicular joint injuries
Clavicle fractures&acromio clavicular joint injuries
madhavigopalrao
 

Similar to I. a. # calc 2015 vaibhav gandhi (20)

prosthodontic management of maxillectomy/obturators part 2 final copy
prosthodontic management of maxillectomy/obturators part 2 final copyprosthodontic management of maxillectomy/obturators part 2 final copy
prosthodontic management of maxillectomy/obturators part 2 final copy
 
PROSTHODONTIC MANAGEMENT OF MAXILLECTOMY/ OBTURATORS PART 2
PROSTHODONTIC MANAGEMENT OF MAXILLECTOMY/ OBTURATORS PART 2PROSTHODONTIC MANAGEMENT OF MAXILLECTOMY/ OBTURATORS PART 2
PROSTHODONTIC MANAGEMENT OF MAXILLECTOMY/ OBTURATORS PART 2
 
Lecture ucmc pilon plafond fracture distal tibia
Lecture ucmc pilon plafond fracture distal tibiaLecture ucmc pilon plafond fracture distal tibia
Lecture ucmc pilon plafond fracture distal tibia
 
Meniscus repair Indication & Techniques.ppt
Meniscus repair Indication & Techniques.pptMeniscus repair Indication & Techniques.ppt
Meniscus repair Indication & Techniques.ppt
 
Hip anatomy, approaches & AVN
Hip anatomy, approaches & AVN Hip anatomy, approaches & AVN
Hip anatomy, approaches & AVN
 
Hip Joint anatomy, surgical approches & AVN review
Hip Joint anatomy, surgical approches & AVN reviewHip Joint anatomy, surgical approches & AVN review
Hip Joint anatomy, surgical approches & AVN review
 
Arhtroscopy of shoulder
Arhtroscopy of shoulderArhtroscopy of shoulder
Arhtroscopy of shoulder
 
Talus fracture treatment algorithm
Talus fracture treatment algorithmTalus fracture treatment algorithm
Talus fracture treatment algorithm
 
Raj Hook Plate
Raj Hook PlateRaj Hook Plate
Raj Hook Plate
 
Medial meniscus injury and physiotherapy treatment
Medial meniscus injury and physiotherapy treatmentMedial meniscus injury and physiotherapy treatment
Medial meniscus injury and physiotherapy treatment
 
Hallux valgus UG lecture
Hallux valgus UG lectureHallux valgus UG lecture
Hallux valgus UG lecture
 
Giant cell tumour of bone
Giant cell tumour of boneGiant cell tumour of bone
Giant cell tumour of bone
 
5 pediatric #
5 pediatric #5 pediatric #
5 pediatric #
 
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
MENISCUS REPAIR  I Dr.RAJAT JANGIR JAIPURMENISCUS REPAIR  I Dr.RAJAT JANGIR JAIPUR
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
 
Meniscus Transplant and Replacement
Meniscus Transplant and ReplacementMeniscus Transplant and Replacement
Meniscus Transplant and Replacement
 
MAISONNEUVE FRACTURE OF ANKLE JOINT
MAISONNEUVE FRACTURE OF ANKLE JOINT MAISONNEUVE FRACTURE OF ANKLE JOINT
MAISONNEUVE FRACTURE OF ANKLE JOINT
 
Maisonneuve fracture of ankle joint
Maisonneuve fracture of ankle joint Maisonneuve fracture of ankle joint
Maisonneuve fracture of ankle joint
 
Biologic Knee Replacement Presentation
Biologic Knee Replacement PresentationBiologic Knee Replacement Presentation
Biologic Knee Replacement Presentation
 
Clavicle fractures&acromio clavicular joint injuries
Clavicle fractures&acromio clavicular joint injuriesClavicle fractures&acromio clavicular joint injuries
Clavicle fractures&acromio clavicular joint injuries
 
Temporomandibular joint ankylosis
Temporomandibular   joint ankylosisTemporomandibular   joint ankylosis
Temporomandibular joint ankylosis
 

Recently uploaded

Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan 087776558899
 
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
Sheetaleventcompany
 
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
rajnisinghkjn
 
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Sheetaleventcompany
 
Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...
Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...
Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...
amritaverma53
 

Recently uploaded (20)

Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
 
Low Cost Call Girls Bangalore {9179660964} ❤️VVIP NISHA Call Girls in Bangalo...
Low Cost Call Girls Bangalore {9179660964} ❤️VVIP NISHA Call Girls in Bangalo...Low Cost Call Girls Bangalore {9179660964} ❤️VVIP NISHA Call Girls in Bangalo...
Low Cost Call Girls Bangalore {9179660964} ❤️VVIP NISHA Call Girls in Bangalo...
 
Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...
Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...
Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...
 
❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...
❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...
❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...
 
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
 
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book nowChennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
 
tongue disease lecture Dr Assadawy legacy
tongue disease lecture Dr Assadawy legacytongue disease lecture Dr Assadawy legacy
tongue disease lecture Dr Assadawy legacy
 
Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...
Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...
Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...
 
Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available
Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service AvailableCall Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available
Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available
 
❤️Call Girl Service In Chandigarh☎️9814379184☎️ Call Girl in Chandigarh☎️ Cha...
❤️Call Girl Service In Chandigarh☎️9814379184☎️ Call Girl in Chandigarh☎️ Cha...❤️Call Girl Service In Chandigarh☎️9814379184☎️ Call Girl in Chandigarh☎️ Cha...
❤️Call Girl Service In Chandigarh☎️9814379184☎️ Call Girl in Chandigarh☎️ Cha...
 
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
 
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptxANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
 
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
 
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
 
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
 
Cardiac Output, Venous Return, and Their Regulation
Cardiac Output, Venous Return, and Their RegulationCardiac Output, Venous Return, and Their Regulation
Cardiac Output, Venous Return, and Their Regulation
 
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
 
Call 8250092165 Patna Call Girls ₹4.5k Cash Payment With Room Delivery
Call 8250092165 Patna Call Girls ₹4.5k Cash Payment With Room DeliveryCall 8250092165 Patna Call Girls ₹4.5k Cash Payment With Room Delivery
Call 8250092165 Patna Call Girls ₹4.5k Cash Payment With Room Delivery
 
Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...
Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...
Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...
 
Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available
 

I. a. # calc 2015 vaibhav gandhi

  • 1. DR.VAIBHAV GANDHI M.S. [ ORTHO ] VEETARAG HOSPITAL, AKLUJ.Maharashtra, India, 413101 Calcaneus Fractures -- MIS
  • 3.
  • 4.
  • 5. Calcaneus Fractures  2 % of # in Young Adults  Most common of all tarsal bone fractures – 60 %  Very challenging injuries  Wide variety of fracture patterns Once considered “ in-operable ”  New surgical technique,  CT has made intervention more beneficial
  • 6.
  • 7.
  • 8.
  • 9. Wide variety of fracture patterns
  • 10. • Essex Lopresti • A.O. • Sandders [ C.T. Based ]
  • 11.
  • 12.
  • 13.
  • 14. • 70% of all calcaneus fractures • Usually fall from height • Heel everted at time of injury • Massive swelling • Compartment syndromes in 10 % • Skin complications • 50% have associated injuries • T&L Spine in 10%, bilateral 5%, • open # 5%, # neck femur Calcaneus Fractures: Intra-articular
  • 15. Treatment Objectives Re- Establish the height of the Calcaneum Reduce the widening of the bone Reduce the lateral & planter protrusions of the bone Re-establish the axis of posterior fragment in frontal plane Near anatomical reduction of the joint
  • 17. • Calcaneus fractures often results in a varus deformity of the heel • Heel widening, • Loss of calcaneal height, • Subtalar joint incongruency • Peroneal Impingment , Pain Conservative Line of Treatment
  • 18.
  • 19. CalcaneusFractures: Treatment  Timing of surgery  Positive “wrinkle test”  Edematous skin heals poorly  ORIF within first 24 hrs  Or wait 1-3 weeks
  • 20. ORIF of a calcaneus fracture is made difficult by the complex anatomy, the presence of soft cancellous bone (which is not amenable to many screw fixation), and the high incidence of postoperative wound infection and skin breakdown.
  • 21.
  • 22.
  • 23.
  • 24. M I S  Close reduction with percutaneous fixation has a lower risk of wound complications, a shorter operative time, and more rapid healing because the soft tissue is handled less.  This approach is good in patient with significant co-morbidity, soft tissue compromise & polytrauma cases also.  The goals of this approach include improvement of heel alignment and reduction of the posterior facet.
  • 25. Surgical Technique  The patient is placed in Supine Position on the Radiolucent OT table under suitable anaesthesia without tournqiet .  To achieve correct placement / reduction; the surgeon holds the heel of the patient with both hands and applies compression both medially and laterally with his thenar muscle to reduce the Broadening & manually correct the heel varus
  • 26.
  • 27. Surgical Technique  A Steinmann pin [ small bone spike] is put into the dorso-lateral calcaneus beneath the posterior facet with a stab incision on Lat. wall skin Joystick manipulation done to elevate the post. Facet.  With the use of the X-ray image intensifier, the restoration of Böhler’s angle and the reduction of the posterior facet is verified.
  • 28.
  • 29. Surgical Technique  The fragments are fixed with percutaneus Kirschner wires. All of the main fragments to be reduced are hold in place by the K wires . During this step , forefoot is flexed Planter wards  The wires are bent above the skin level . OR  One 6.5 mm Cann. Canc. Screw in sagittal plane from Post. Tuberosity Postero- Superior to Antero- Inf. planter direction , supporting the crucial post & middle articular facet and one horizontal screw in coronal plane from Sust. Tali to lateral wall , in anteromedial to posterolateral direction.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38. case 1 - 46 yrs / male
  • 39. case 1 - 46 yrs / male
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 49.
  • 50.
  • 51.
  • 52.
  • 54.
  • 55. MIS
  • 56.
  • 57.
  • 58.
  • 59.
  • 60.
  • 61.
  • 62.
  • 65. Calcaneus Fractures  Complications  Gravity related swelling  Skin and wound healing problems  Compartment syndrome  Sural N. injury  Infection / COM  Malunion / Subtalar Arthritis  Chronic Heel Pain.  Peroneal Impingement.
  • 66. M.I. S. RESULTS  Close reduction with percutaneous fixation has a lower risk of wound complications, a shorter operative time, and more rapid healing because the soft tissue is handled less.  This approach is good in patients with significant co-morbidity, soft tissue compromise & polytrauma .  The goals of this approach include improvement of heel alignment and reduction of the posterior facet. prevention of broadening of calcaneus & restoration of height of calcaneus.