OPERATION IN DETAIL: The patient was brought to the OR and laid supine on the OR table. After general anesthesia was induced, the patient was turned over to the prone position. All bony prominences were well padded. A tourniquet had been placed high up on the left thigh prior to the patient being turned prone. The left lower extremity was then prepped and draped in the usual sterile fashion. Esmarch bandage was used to exsanguinate the left lower extremity and the tourniquet was inflated to 300 mmHg. Next, a 12 cm incision longitudinally was made just medial to the Achilles tendon. The Achilles tendon was identified. Next, the fracture through the calcaneal tuberosity was identified and this area was cleaned of fibrin clots and all bullet fragments were removed. Next, the patient's foot was placed into plantar flexion. A transverse incision was made through the heel pad. Two drill holes were passed from the plantar aspect of the calcaneus up through the fractured surface. Next, Ti-Cron sutures were passed with a straight needle through these holes. Next, a Krackow-type suture was performed extending approximately 4 cm up into the Achilles tendon substance. These sutures were then brought back down and passed through the drill holes that were made in the calcaneus and brought out through the plantar aspect of the calcaneus using a straight needle. The foot was placed into full plantar flexion and suture was tied down tightly. Excellent fixation of the Achilles tendon into the calcaneus was obtained after final tightening. Next, there was noted to be a bone fragment with the Achilles tendon attached to which a screw could be placed for additional fixation. Therefore, a 35 mm partially threaded cortical screw was placed into the calcaneus fixating this bone fragment. Next, the wound was thoroughly irrigated with normal saline and the tourniquet was deflated and hemostasis was obtained. The wound was closed using a 2-0 Vicryl suture for the subcutaneous layer followed by staples for the skin. Sterile dressings were applied and the patient was placed into a splint in plantar flexion. The patient was then awakened from anesthesia and taken to the PACU for recovery.
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