Calcaneus fractures: rationale for the medial approach technique of reduction

The fractured calcaneus is an enigma to many orthopedic surgeons. Because of this they are often not reduced as well as they might be. The majority of these fractures can be adequately reduced by the medial approach. This approach is based on the fact that a definite pattern of fracture occurs on the medial side of the calcaneus, whereas there is no pattern on the lateral side. If one restores the medial wall of the calcaneus, which is most accurately done from the medial side, the height, length, and much of the width is restored. Strong pressure over the lateral bulge is necessary to completely restore normal width. Generally, the tongue or joint depression-type fragments can be reduced from the medial side. If not, a separate, lateral incision is used to insure their reduction. The neurovascular bundle is no longer dissected out, removing a psychological barrier to the medial approach. A strong recommendation is made to use the longitudinal pin method of fixation. It is simple, and extremely strong. A classification of calcaneus fractures is presented, which can help in preoperative planning for reduction of these fractures.