The medical approach for calcaneal fractures.

A practical classification of calcaneus fractures based on standard heel roentgenograms and Brodén's views is presented. Diagnosis is made from these roentgenograms, even though many believe that more sophisticated studies are needed. In fact, only the Brodén's and lateral views are needed for diagnosis. What one needs to know is the type of fracture present, whether it is a tongue or joint depression-type fracture, and the width of the fragment. The necessary information is easily determined from these roentgenograms. Once these facts are known, a plan of approach can be made. The medial approach is an indirect method of reduction as one might use for the tibia or femur fracture. Experience has shown that the longitudinal threaded pin is an excellent method of stabilization. It is quick and effective. It has eliminated the need for exposure of the neurovascular bundle. Minimal metal is implanted, and a smaller incision is used. Most common calcaneal fractures can be reduced well from the medial side. A few may need lateral reduction also, but this is simplified if the nonarticular components of the fracture are reduced first by the medial approach technique. The results of the medial approach technique have been much better in the last 12 years. This is attributed to the classification, the knowledgeable interpretation of the roentgenograms, and use of the threaded longitudinal pin for fixation.