Minimally Invasive K‑Wire and Screw Fixation for Calcaneal Fractures

1. Diagnosis

Example image: CT shows a displaced fracture of the posterior facet as a single fragment, amenable to minimally invasive elevation and fixation with a subchondral lag screw.

2. Surgical Approach

Either the sinus tarsi approach or a minimally invasive lateral approach can be used.

3. Reduction

Preoperative preparation
The patient is positioned in the lateral decubitus position. Under image intensifier control, a Steinmann pin is inserted into the posterior tuberosity of the calcaneus to serve as a joystick for restoring calcaneal length.

Elevation of the depressed fragment
Under fluoroscopic guidance, a small incision (e.g., sinus tarsi approach) is made over the fracture centre. A periosteal elevator is inserted to lift the depressed fragment and restore articular congruity.

Maintenance of reduction
A distractor is used to assist in maintaining the reduction, and fluoroscopy is performed to confirm adequate reduction.

Example image: Fluoroscopic view showing elevation of the posterior facet using a distractor through a 3‑cm incision.

Percutaneous K‑wires or screws are then placed to hold the reduction; bone substitute may be packed into the defect to stabilise the fragments and promote healing.

4. Fixation

K‑wire fixation
Postoperative X‑rays show restoration of Böhler's angle, with K‑wires inserted from the posterior tuberosity into the posterior facet and bone substitute filling the defect (through only a 2‑cm incision).

The images demonstrate the reduced posterior facet in two projections, fixed with K‑wires.

Screw or plate fixation
In addition to K‑wires, percutaneous screws or plates can also be used for fixation.

5. Postoperative Management

Initially, a bulky posterior splint is applied to maintain the ankle in a neutral position, with intermittent elevation of the affected limb.

Ankle range‑of‑motion exercises are started as early as 2–5 days postoperatively. Routine cleaning is performed to prevent pin‑tract infection.

K‑wire removal: not earlier than 6 weeks (example image shows K‑wire status at 6 weeks).

Weight bearing: delayed until after pin removal at 6 weeks.

Imaging follow‑up: lateral and axial X‑rays are obtained at 6, 12, and 26 weeks postoperatively.