Updates on Fracture Fixation

Anaesthesia

A 1–2 cm incision is performed from the tip of the fibula to the base of the fourth metatarsal.
Careful dissection is performed when the peroneal tendons and the sural nerve are met.
Another lateral incision of 0.5 cm is performed under the STA incision
A vessel forceps or a periosteal elevator is inserted in the incision from the lateral fragment to the bottom of the medial wall of the calcaneus.
Then, the medial sustentacular fragment is elevated over the calcaneal tuberosity.
The outward displaced calcaneal tuberosity, varus deformity, calcaneal height, and medial wall overlap are corrected, then 1 or 2 2.0-mm K-wires temporarily fix the fragments.
One or two 4.5-mm screws are placed from lateral posterior facet to the medial sustentacular fragment.
From the calcaneus tubercle towards the anterior process, one or two 5.5-mm cannulated screws are inserted through the calcaneus length.
One screw is placed from the calcaneus tubercle to the sustentaculum tali or another screw is placed from the calcaneus tubercle to the lateral joint fragments.
One rubber drain is inserted in the wound before closing the incision.

Prophylactic antibiotics are applied for 1–3 days postoperatively.
Stitches are removed routinely 7–10 days postoperatively.
A long arm splint is used to immobilize the elbow for 1 week, and the elbows are further partially immobilized for 5–8 weeks using a long arm splint or hinged brace if needed.
No external fixators are used in any of our cases.

Emergency surgery using STA with modified reduction technique is effective and safe for calcaneum fractures
Emergency surgery using STA with modified reduction technique could be an alternative method for calcaneal fracture.
Using this method, it can give ideal clinical outcomes, and a low rate of wound complications, reducing the in-hospital time, costs and accelerating rehabilitation.