Calcaneal Fracture Fixation (Open Reduction and Internal Fixation)

A calcaneal fracture fixation, or open reduction and internal fixation (ORIF) for heel fractures, is a surgical procedure designed to treat severe calcaneus (heel bone) fractures. These fractures typically occur during high-impact events like falls from heights or motor vehicle crashes.

The surgery involves realigning the fractured bone fragments to their normal position to facilitate long-term, proper healing. Stabilizing the broken pieces with internal fixation methods like screws or plates aims to restore normal foot function and prevent long-term issues associated with severe calcaneal fractures.

Why is a Calcaneal Fracture Fixation Performed?

A fracture of the calcaneus can occur for numerous reasons. High-impact events on the axial loading part of the bone, such as falling from extreme heights, automobile accidents, jumping on hard surfaces, or any blunt trauma that causes the bone to flatten, widen, or shorten, can injure the foot or ankle. Repetitive athletic activities like running can also cause stress fractures from overuse.

Surgical treatment for a broken heel bone focuses on restoring heel height and width, reconstructing anatomical angles, repairing and realigning the subtalar joint, and ensuring the hindfoot's mechanical axis functions appropriately. The primary goal of heel fracture surgery, like calcaneal fracture fixation, is to bring the heel bone as close to its normal shape as possible and correct lost alignment and contour in the broken bone, optimizing function and minimizing pain.

How to Prepare for a Calcaneal Fracture Fixation

As with all surgical procedures, you should refrain from drinking or eating in the hours before the surgery. Ahead of the procedure, the doctor will ask about any medications you take, and specify which ones you need to pause in the days before the surgery. These may include blood thinners or aspirin, among others. Arrange transportation to and from the surgical facility and wear comfortable clothing on the day of the procedure.

In the days before the surgery, it's important to follow preoperative revalidation protocol and elevate the affected foot to reduce swelling, compress the area with a foot pump or wraps, and use crutches or a wheelchair to get around. Ask your physician any questions about the procedure.

What Happens During a Calcaneal Fracture Fixation?

A calcaneal fracture fixation is a relatively straightforward procedure which adheres to the following protocol:

  1. Patient Preparation: The patient is positioned appropriately, and anesthesia is administered to ensure comfort during the procedure.
  2. Incision: The surgeon makes one or more incisions on the foot to access the fractured calcaneus.
  3. Fracture Realignment and Fixation: The physician carefully realigns the fractured bones to restore normal alignment. Based on your specific case, the doctor will use screws, plates, or wires to stabilize the fracture and correct alignment. If needed, guide wires are inserted into the bone to assist with stabilization, and a bone graft may be used to fill the space created by the fracture. In a traditional "open" procedure, the surgeon makes an incision over the heel in a shape resembling a hockey stick or a large "L." This incision allows for repositioning the fractured bones while carefully moving the overlying nerves and tendons aside.
  4. Closure and Bandaging: When the procedure is complete, incisions are closed. The foot is then bandaged and placed in a splint or padded cast.

The duration of the calcaneal fracture fixation procedure may vary but generally takes a few hours, depending on the complexity of the fracture.

Are There Risks Associated With a Calcaneal Fracture Fixation?

It's essential to be aware of certain complications that may occur with calcaneus fractures, including:

  • Chronic pain and swelling
  • Joint stiffness
  • Tendon irritation
  • Nerve pain around the point of incision
  • Potential delayed wound healing

More severe complications can occur, including infection, posttraumatic arthritis, or failure of the wound to heal.

It's important to tell your doctor if you are a smoker because smoking may affect bone and skin healing. Some physicians may recommend alternative approaches since smoking increases the risk of serious complications.

Post Calcaneal Fracture Fixation and Recovery

After a calcaneal fracture fixation, patients cannot bear weight on the foot for about six to twelve weeks. Some patients may begin weight-bearing activities a few weeks after injury or surgery, while others may need to wait three or more months before putting any weight on the heel, depending on the severity of the treated fracture.

It's crucial to begin a regular physical therapy routine to improve the range of motion and strengthen supporting muscles around the foot and ankle. Early movement of the foot and ankle is encouraged during recovery, starting once the wound has healed. Adherence to the doctor's instructions for walking is crucial to prevent bone displacement, potential surgery, or complications such as screw loosening or breakage. Use a special boot or walking brace to get around and consult with your physician.

Some patients may experience residual pain during recovery and may need a splint or cast. Do not bear weight on the operated foot for at least 6-8 weeks to facilitate healing and prevent permanent loss of motion. Refrain from activities that may jeopardize recovery, such as using hot tubs, pools, or applying lotions/creams without a prescription. Follow your physician's guidelines and contact them immediately if you're experiencing any unusual symptoms or complications during the recovery period.

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