Therapy of a calcaneal fracture | Therapy of a calcaneal fracture

Therapy of a calcaneal fracture

As is often the case, when treating a calcaneal fracture, one has the choice between conservative and surgical treatment. Which one is chosen depends on at least two factors. First of all, there is the question of whether or not it is a dislocated fracture, i.e. one in which bone fragments are displaced.

Secondly, we are interested in the condition of the surrounding soft tissue and its blood circulation. In the case of a calcaneal fracture that is not or only slightly dislocated, a conservative therapy is often chosen. It would also be the first choice for a comminuted fracture.

If the blood circulation and soft tissue situation is critical, this is also a reason for conservative treatment. This usually involves relieving and protecting the heel in a special splint for about six weeks. During this time, the therapy can be supported with painkillers and physiotherapy.

After the relief phase, the heel bone is checked radiologically. If the radiographic check shows good and timely progress in healing, the heel bone can be gradually put under more weight again. If necessary, insoles can be prescribed to further protect the heel bone and compensate for possible foot malpositions.

Any dislocated and open fracture of the calcaneus should be treated surgically if the soft tissue situation is not critical. It is always an advantage if the fracture consists of only a few fragments so that they can be better fixed in their original position.Should the calcaneal fracture nevertheless consist of several pieces of debris, the fracture can be stabilized in a closed reduction with special wires inserted from the outside. Roughly speaking, the bone debris is threaded so that the resulting fixation corresponds to the original heel bone shape.

Inaccuracies at the joint surface cannot always be prevented. But compared to open surgery, soft-tissue infections occur less frequently and even complicated comminuted fractures can be effectively stabilized. Open surgery is an alternative to closed reduction of the calcaneal fracture.

This usually consists of a reduction of the fracture fragments to their original position and fixation with either screws, a tension strap wire or a plate. Here, a particularly gentle handling of the surrounding soft tissue must be emphasized in order to avoid postoperative wound healing disruption due to circulatory problems and excessive soft tissue defects. In addition, infections of the wound should be avoided if possible or treated immediately in order not to jeopardize the success of the surgical treatment and to keep the spread of the soft tissue defect as small as possible.

The procedure in the case of a so-called “duck’s beak fracture” of the calcaneus is often performed after correction of the shape of the bone, which is fixed with certain cancellous bone screws so that the Achilles tendon, which in this case is anchored to the fractured bone part, can no longer mobilize it. As an alternative to the cancellous bone screw, a tension wire, which can be inserted through predrilled holes in the avulsion fragment and in the calcaneus, can also be used for fixation. For the surgical treatment of the other types of calcaneal fractures, especially impression fractures, surgery with open correction of the bone shape and fixation with a plate is often used.

When inserting the plate, careful attention should be paid to the course of resident nerves and vessels in order not to injure them. The procedure is usually performed from the inside of the fracture to the outside. Additional wires and screws can be used to further secure the bone parts in the correct position.

In most cases, a drainage is inserted at the end of the operation to allow wound fluid to drain away. However, this can usually be removed relatively early. Otherwise, the postoperative treatment of a heel fracture is based on protecting the heel for about four to six weeks and wearing a walking frame to relieve the heel bone. In addition, physiotherapy can be prescribed to restore mobility. If the heel bone fracture heals properly and without complications, the heel bone can slowly be put under more weight again after it has been spared.