Benirschke and Sangeorzan describe the University of Washington technique for displaced intraarticular calcaneal fractures. The paper covers fracture anatomy, two-plane CT planning, patient selection, stepwise surgical reduction, and postoperative rehabilitation. Results from 80 operatively treated fractures report wound complications, subtalar ROM recovery, and salvage arthrodesis rates.
Calcaneal fractures cycled through operative and nonoperative eras for over a century, with poor results on both sides. This paper provided the technical framework that shifted the field toward operative fixation by pairing a reproducible extensile lateral approach with CT-guided planning and rigid internal fixation.
When you see a displaced intraarticular calcaneal fracture, order CT in both the plantar and semicoronal planes before planning surgery. Screen for contraindications: peripheral vascular disease, insensate neuropathy, and inability to comply with 10–12 weeks of non-weight-bearing are reasons to reconsider operative treatment.
Intraoperatively, reduce in sequence: anterior process first, then tuberosity to sustentaculum, then elevate the posterior facet. Direct screws into the sustentaculum (the densest calcaneal bone). Contour the plate in a 'frown' shape to prevent fixing the heel in varus — an intraoperative axial view confirms neutral alignment before final plate application.
Tell patients upfront: subtalar motion will recover to roughly half the contralateral side, and about 1 in 25 will need a subtalar fusion down the road.
Benirschke and Sangeorzan describe the University of Washington technique for displaced intraarticular calcaneal fractures. The paper covers fracture anatomy, two-plane CT planning, patient selection, stepwise surgical reduction, and postoperative rehabilitation. Results from 80 operatively treated fractures report wound complications, subtalar ROM recovery, and salvage arthrodesis rates.
Calcaneal fractures cycled through operative and nonoperative eras for over a century, with poor results on both sides. This paper provided the technical framework that shifted the field toward operative fixation by pairing a reproducible extensile lateral approach with CT-guided planning and rigid internal fixation.
When you see a displaced intraarticular calcaneal fracture, order CT in both the plantar and semicoronal planes before planning surgery. Screen for contraindications: peripheral vascular disease, insensate neuropathy, and inability to comply with 10–12 weeks of non-weight-bearing are reasons to reconsider operative treatment.
Intraoperatively, reduce in sequence: anterior process first, then tuberosity to sustentaculum, then elevate the posterior facet. Direct screws into the sustentaculum (the densest calcaneal bone). Contour the plate in a 'frown' shape to prevent fixing the heel in varus — an intraoperative axial view confirms neutral alignment before final plate application.
Tell patients upfront: subtalar motion will recover to roughly half the contralateral side, and about 1 in 25 will need a subtalar fusion down the road.