Heel Bone Fractures (Calcaneus Fractures): Repair With a Plate and Screws

Heel Bone Fractures (Calcaneus Fractures): Repair With a Plate and Screws

This video will provide a cadaveric surgical demonstration of a repair to a fracture of the heel bone, also known as the calcaneus bone. A plate and screws will be used. To treat these fractures, a large incision is often needed over the outside of the heel. However, this demonstration will show a technique using smaller surgical incisions.

The surgeon begins by showing the anatomical markings for the surgical incision on the outside of the right foot. The end of the fibula bone is marked here. The incision will be made just below this. The incision has now been made and a pin has been placed in the back of the heel. The pin will serve as a joystick, allowing the surgeon to control the heel's position and move the fracture into normal alignment.

The surgeon is shown clearing a path for the plate under important tendons on the outside of the ankle, called the peroneal tendons. A surgical retractor will be used to hold the tissues out of the path of the procedure. Once the path is cleared, the surgeon is shown moving the pin, which moves the heel into the proper alignment.

Once the surgeon is pleased with the heel's placement, a temporary wire will be placed to hold the position. The handle of the larger pin will then be removed. The plate is placed under the soft tissue and over the bone. A small ball-tipped temporary wire holds the plate to the bone. Another temporary wire will be placed in the oblong hole of the plate and bone to further secure the plate's position.

A guide will then be placed over the plate and recently placed wire. The surgeon is shown securing the guide to the plate. The guide will mirror the plate's position under the skin. Once complete, the surgeon will begin placing the first screw, which will be done on the furthest hole in the plate. A small incision will be made under this hole in the guide, corresponding to a hole in the plate beneath the skin. The incision and soft tissue will be carefully opened down to the plate.

Then, a drill guide is placed through the guide and screwed into the plate on the bone. A drill will be used through the guide, which also allows the surgeon to measure the length of the hole. The guide is removed, and the proper-sized screw is placed. The first ball-tipped wire has been removed to place another screw in the front of the plate. This screw is a locking screw.

Locking screws have threads that engage with corresponding threads in the plate, which help minimize movement of the hardware and help compress the fracture sites for optimal healing. Often, locking and nonlocking screws are used in combination to achieve adequate compression and stability of the fracture site. The locking screw will be inserted and another screw will be placed in the back of the plate through the same small incision previously made.

The guide can now be removed. A measuring guide will be used over the wire in the oblong hole to determine the size of the screw that will go in this position. Once completed, a hollow-bodied drill bit will be placed over the wire, and a hole will be drilled. A hollow-bodied screw, called a canulated screw, will be placed over the wire and screwed into the oblong hole. The wire will then be removed.

In similar fashion to previous screws, the final screw is placed at the front of the plate. The pin and wire in the back of the heel will be removed. X-rays will be done throughout the procedure to confirm placement of the hardware. Once the final screw is in place, the incision will be closed, and the surgery will be complete.