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Calcaneal Fracture ORIF

The term “ORIF” stands for “open reduction, internal fixation”. The goal is to move your bones back to their original position prior to the injury. By restoring the normal alignment, we provide the patient with the best possible outcome. However, the final outcome often depends on the severity of the initial injury. Simple fracture patterns with minimal displacement and large bone pieces are easier to treat than highly complex fractures involving many small pieces. During surgery, these small pieces all need to be carefully placed in their original position. This challenging endeavor is equivalent to putting a broken eggshell back together.

 

Conditions

The main indication  that you need this type of surgery on your heel bone (calcaneus fracture) is a displaced fracture. Displaced means the bone fragments are “out of position” and must be put back together. A calcaneus fracture commonly includes damage to the subtalar joint. This is the joint that allows side-to-side movement of your foot. A damaged joint can lead to arthritis. By putting these broken pieces back together, we hope to maximize the functional outcome and reduce the chance of developing arthritis. However, not all patients with calcaneal fractures are candidates for surgery. Certain fractures are not displaced enough to need surgery. And for other patients, the risk of a serious complication (such as a deep infection) may outweigh the potential benefits of surgery. We will determine the best method based on our evaluation.

 

Surgery

Some fractures can be fixed through small incisions and others require longer incisions.

  • During surgery, you will be positioned on your side.
  • The incision is made on the outside (lateral) aspect of your foot. We will determine the type and shape of this incision.
  • Once the skin incision is made, we will carefully move important tendons, nerves, and ligaments out of the way in an effort to visualize the underlying calcaneus bone. Sometimes these tendons, nerves, and ligaments are damaged along with the calcaneal bone and need to be repaired too.
  • Once the bone is exposed, we will make an effort to inspect the subtalar joint.
  • Once the surgical exposure is complete, we will start the process of systematically reassembling the bone pieces.
  • There are usually two primary fragments making up your fractured calcaneus. These fragments are realigned first and temporarily fixed with wires to hold them in place. Proper alignment is confirmed by the use of a live x-ray machine (called a C-arm).
  • Next, we will reconstruct the subtalar joint surface by systematically repositioning all other fracture fragments.
  • Once the calcaneal alignment is restored, we will remove the temporary wires and replace them with permanent hardware, such as plates and/or screws.
  • The final step involves the closure of the surgical wound. In some ways, this is the most important part of the surgical procedure because any breakdown of the wound will increase the risk of significant post-operative infection.
  • Once the wound closure is complete, a soft cast (called a splint) is applied to the leg.

 

Rehabilitation

During recovery:

  • Your foot is immobilized in the soft cast (splint), iced and elevated. We will instruct you not to place any weight on your foot. This will require the use of a wheelchair, walker, knee scooter and/or crutches. We will likely prescribe strong pain pills. Over-the-counter laxatives and stool softeners may be required to prevent or treat constipation. Your dressing should remain clean and dry. Do not change your dressing unless instructed.
  • At your first post-operative visit, we will remove your splint and examine your incision. Sutures may need to be removed. You will be placed either into a cast or a removable boot. For most calcaneus fractures, we will ask that you remain non-weight-bearing until the fracture demonstrates adequate healing as seen on x-rays. If you are placed in the removable boot, we may ask that you start a gentle range-of-motion rehabilitative program.
  • Once the bone has completely healed, you will begin more advanced physical therapy activities (such as walking without a limp and improving your balance strength). You will see a gradual reduction of swelling, although expect your foot/ankle to remain swollen for many months after surgery.
  • Full recovery can often take 6-12 months.

 

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