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Open Reduction and Internal Fixation of Right Calcaneus Operative MT Sample Report

OPERATION IN DETAIL:  The patient was brought to the operating room and laid supine on the operating table. After general anesthesia was induced, the patient was turned to the lateral decubitus position. All bony prominences were well padded. A tourniquet was placed high upon the right thigh and the right lower extremity was prepped and draped in the usual sterile fashion. Next, an L-shaped incision was made, performing a standard lateral approach to the calcaneus. Full-thickness skin flaps were raised. Subperiosteal elevation of the anterior flap was performed using sharp dissection. Care was taken to protect the peroneal nerves as well as the sural nerve and the peroneus tertius tendon distally. The calcaneus fracture was exposed. The lateral wall was removed. Next, a Steinmann pin was placed into the calcaneal tuberosity through the heel through a separate stab incision. Next, the fracture was opened using a combination of elevators and Cobbs. Next, the calcaneal tuberosity was brought into valgus. Preoperative plain films showed a significant fracture deformity of the hindfoot. This was corrected intraoperatively using the Schanz pin. Next, attention was turned to performing reduction of the posterior facet. With direct visualization, the posterior facet was reduced. Two 2.0 K wires were placed from posterior to anterior, holding the posterior facet reduced. C-arm fluoroscopy was used to confirm good restoration of the hindfoot alignment, which was taken out of varus and brought into neutral alignment. The facet was reduced under direct visualization. It was difficult to reduce the anterior process of the calcaneus, as any attempt at reduction of this anterior portion would lead to gapping of the posterior facet. Therefore, we decided to perform an anatomic reduction of the posterior facet and accept the upward tilt of the anterior process of the calcaneus. As mentioned, the varus deformity was corrected intraoperatively. Next, a calcaneal plate from the DePuy set was selected and fashioned to the lateral aspect of the calcaneus. Two screws were placed distal into the calcaneal tuberosity and two screws under the facet joint. Another screw was placed in the calcaneus. C-arm fluoroscopy was used to confirm good length of all screws. Final reduction was checked under C-arm fluoroscopy as well and was felt to be acceptable. Next, the wound was thoroughly irrigated with normal saline. A drain was placed and brought out the dorsum of the foot. Next, 0 Vicryl suture was used to close the flaps. The skin was closed using 3-0 nylon suture using a corner stitch fashion throughout the incision. Sterile dressings were applied. The patient was placed into an AO splint. The tourniquet was deflated prior to closure and hemostasis was obtained. The patient was then turned to the supine position and was extubated in the operating room and taken to the PACU for recovery. There were no complications.


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