1. Case for small group discussion
Calcaneal fracture
Case for small group discussion
AOTrauma—Foot & Ankle
Module 2a: Hindfoot trauma—calcaneal fractures
Hans Zwipp and Stefan Rammelt, DE

2. Case description 36-year-old man Motor vehicle accident Closed injury
Severe ankle and hindfoot pain
Abnormal contour of heel and malleolar region

3. Preoperative CT scans
Day 0

4. Modified palmer approach
McReynolds approach
Day 9

5. Modified palmer approach for fracture dislocations—intraoperative images
Fibula T SU TU
TU: Tuberosity fragment
SU: Sustentacular fragment PT
Day 9

6. Postoperative x-rays
Day 9

7. Postoperative x-rays

8. 15-month follow-up
Standing
Standing

9. 15-month follow-up

10. Take-home messages High index of suspicion
Pattern recognition (double contour, direct fibular fracture)
Direct lateral approach starting at the tip of the fibula to address both calcaneal fracture dislocation and peroneal tendon dislocation with fibular fracture if present
Often two-part fracture within the posterior facet
Compression screw fixation to the sustentaculum
Antiglide plate fixation from medial
References:
Rammelt S, Zwipp H. Calcaneus fractures: facts, controversies and recent developments. Injury May;35(5):443–461.
Zwipp H, Rammelt S, Barthel S. Calcaneal fractures--open reduction and internal fixation (ORIF). Injury Sep;Suppl:SB46–SB54.
Rammelt et al. Injury. 2004;35:443–461.
Zwipp et al. Injury. 2004;Suppl:SB46–SB54.