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Surgery for Calcaneus Fracture

Surgery
Surgery for a calcaneus fracture is called open reduction and internal fixation, or ORIF. It requires hospitalization for at least one night. You will require a general anesthetic.

During the surgery I will make an incision on the outside of the heel shaped like an “L”. The broken pieces of the bone are exposed, and then put back together, or “reduced”. The pieces are then held together with some combination of screws and a plate.

               Calcaneal Plate & Screw 1_edited-1.jpg

The reason to do surgery is to put the bones back together as close as possible to how they were before they broke. This will hopefully restore the shape of the heel, and the joints between the broken heel bone and the adjacent talus and cuboid bones.

                          Calcaneus Fracture2.jpg       

 

 Calcaneus Fracture ORIF a.jpg   Calcaneus Fracture ORIF b.jpg      

Day of Surgery
At the end of the surgical procedure the wound is covered and a short leg plaster splint is applied. That dressing gives support to your ankle, holding it securely. You should leave that in place until I change it at the first post-operative office visit.

                    Calcaneus Wound1.jpg

You should keep your foot elevated as much as possible to minimize swelling.

You will be given crutches or a walker at the hospital, and I want you to not put any weight on that leg during the first 6 weeks. In the hospital a physical therapist will instruct you in using the crutches or walker. Do not walk on the splint.

When your pain is under control, and you can safely get around without putting weight on the ankle, you may go home.  Look here for things to watch for after inpatient surgery.

Post-operative Course
The first post-operative visit is usually 7 – 10 days after surgery. At that time I will remove the splint and dressings, wash your foot, and generally take out the skin staples or stitches

                    Calcaneus Wound2.jpg

I will then put your leg into a CAM Walker. You will use this as a removeable splint, to allow you to begin doing range of motion exercises for the ankle and foot. You must remain non-weightbearing for 6 weeks after surgery, so you will still need to use the crutches or walker. Do not walk on the CAM Walker until 6 weeks have passed.

I will usually see you again after 2 more weeks. I will see then about having you do physical therapy.

The next post-operative visit is usually at the 6 week point. I will get an XRay to see if the bones are healing well. I will then have you begin weightbearing in the CAM Walker. You will use that for an additional 6 weeks of protected weightbearing. You may still remove that boot for bathing, sleeping at night and to do gentle motion exercises. You must wear it when you do any walking.

I will ask to see you one more time after an additional 6 - 8 weeks. If there are any problems or questions then we will deal with them as they present.

Most patients have swelling about the surgical area that lasts for about 4 months after surgery. You should not resume athletic activities for between 4 - 6 months after surgery.

Final Results
The goal of the surgery is to leave you with a painless foot that will allow normal activities. You should be able to regain full strength and power in the leg and ankle. Most people are left with stiffness in hindfoot inversion and eversion. The ankle should move up and down with no restriction of motion. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes. It will usually take a full year for the foot to reach its maximum improvement.

                    Calcaneus Wound3.jpg

Complications
Complications can occur after any surgery.  Go here for a general discussion of Surgical Complications.

Specific risks of this surgery include wound healing problems, injury to the sural nerve, painful arthritis in the subtalar joint, stiffness and the possible need to have further surgery to remove the implants, or fuse the subtalar joint.




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