Open Reduction and Internal Fixation of Intra-Articular Calcaneal Fractures Via an Extensile Lateral Approach.

INTRODUCTION: Although displaced intra-articular calcaneal fractures were historically treated nonoperatively because of unreliable outcomes, they are now commonly treated with open reduction and internal fixation (ORIF). STEP 1 PREOPERATIVE PLANNING AND OPERATIVE SETUP: Coronal images are most helpful. STEP 2 INCISION AND SOFT-TISSUE MANAGEMENT: Elevate the flap using the "no-touch" technique to minimize wound complications. STEP 3 REDUCE POSTERIOR FACET AND PERFORM PROVISIONAL STABILIZATION: Achieve anatomic reduction of the medial calcaneal wall before proceeding with the remainder of the fracture reduction. STEP 4 APPLY LAG FIXATION AND A LATERAL NEUTRALIZATION PLATE: Use a traditional nonlocking plate and be sure that at least one lag screw achieves purchase. STEP 5 CLOSE WOUND: Use the "no-touch" technique, with the goal of tension-free wound closure. STEP 6 POSTOPERATIVE CARE: Watch closely for drainage or delayed healing. RESULTS & PREOP/POSTOP IMAGES: ORIF is a viable treatment option for displaced intra-articular calcaneal fractures without contraindication for older patients. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.