Precautions for calcaneal fracture surgery

In daily life, many of our friends are engaged in special industries, such as the sports industry. The most common consequence of the sports industry is injury or even fracture. For many friends who encounter calcaneal fractures, you first need to adopt the quality of surgery. Let us introduce calcaneal fracture surgery.

Surgical methods and precautions for calcaneal fractures

1. Operation Time: Except for emergency surgery for open fractures, all other cases require a thick cotton pad to apply pressure bandage after the injury, and the affected limb is placed on a Brown's frame to elevate the affected limb, and the surgery is performed about 7-12 days after the injury. If there is severe local edema and tension blisters, dehydration drugs can be added and surgery can be delayed.

2. To reduce and fix unilateral fractures during surgery, patients should lie in the lateral position with the affected foot on top. The patients with bilateral fractures were placed in the supine position, and the operation was performed under epidural anesthesia and tourniquet control. A standard "L"-shaped incision was made on the outside of the heel, and the incision was in an arc shape to allow for better exposure. Starting from 4-6cm above the tip of the lateral malleolus and 1-1.5cm behind the edge of the fibula, go longitudinally downward to the junction of the base and lateral skin, turn forward, reach the upper edge of the base of the fifth metatarsal, incise the skin and subcutaneous tissue, do not perform subcutaneous peeling, avoid damaging the skin blood supply as much as possible, avoid pulling the skin with retractors, and reduce skin necrosis. Pay attention to protecting the sural nerve and the long and short peroneal tendons when incising. Use a sharp knife to peel the entire piece of skin and other soft tissues downward from the surface of the calcaneus, close to the lateral wall of the calcaneus, to reach the lateral and posterior edge of the subtalar joint. Use three 1.5mm or 2.0mm Kirschner wires to nail into the lateral malleolus, talar head, and scaphoid bone respectively, pull the skin flap and the long and short peroneal tendons upward, and fully expose the lateral and posterior sides of the subtalar joint space. On the premise of keeping the shape of the lateral wall bone block intact as much as possible, use the periosteal stripper to pry up the collapsed and flipped joint surface, open the lateral wall bone block like a loose-leaf, and reposition the intra-articular bone block according to the anatomical shape of the calcaneus under direct vision;

At the same time, a thick Kirschner wire is inserted through the apex of the calcaneal tuberosity to pry and reposition the foot plantar flexion; restore the normal anatomical position of the anterior, middle and posterior articular surfaces of the calcaneus, and restore the Bohler's and Gissane's angles. Then the widened inner and outer sides of the calcaneus are squeezed and repositioned to restore the height of the calcaneus. For those with obvious bone defects, autologous iliac bone or allogeneic bone grafts (domestic, Jinshi Bone Grafting Ling) are taken. For those with satisfactory fracture reduction, Kirschner wires are used for temporary fixation, and the outer wall is repositioned and flattened. The moldable calcaneal titanium plate is used for fixation. The Kirschner wire should be fixed on the unfragmented fracture fragment, or fixed to the complete fracture fragment of the contralateral talar process or medial wall through a steel plate, as well as the anterior part of the calcaneus and calcaneal tuberosity, which are not easy to displace and have a higher density. The key to open reduction is to restore the axial arrangement of the tuberosity bone fragment and the talar process or medial wall bone fragment to ensure that there is no varus angulation in the medial wall fracture. Use C-arm fluoroscopy to observe whether the calcaneal morphology and articular surface are satisfactory. When closing the wound, place a drainage skin graft or rubber tube in the surgical field, apply pressure to the wound, and suture the subcutaneous tissue tightly to avoid damaging the sural cutaneous nerve. The affected calf is fixed in a neutral position with a plaster cast. ,

In daily life, friends who have undergone calcaneal fracture surgery need to rest and recuperate, especially for many physical problems. They also need to adjust their diet to allow their bones to recover quickly and eat more nutritious foods.