The Emergent Management of Tongue-type Calcaneal Fractures: Technique Tips

nonthreaded 2.5 mm K-wire into the talus and then one through the anterior process into the calcaneocuboid joint (Fig. 2D).This was found to be stable under live fluoroscopy and determined adequate without the need for replacement with screws.As the patient was polytraumatized, this is an efficient manner to stabilize the fracture and relieve the skin, especially in DCO.Had our patient been more stable, we would recommend introducing fixation into the calcaneus after using this reduction technique.This would be through the sinus tarsi incision, using a mini fragment plate to connect the anterior process to the posterior tuberosity.Finally, we recommend splinting with approximately 20° of plantar flexion.If the patient had poor bone quality, we would recommend using two wires for the tuberosity manipulation to spread the load and to avoid cut out of the screws.Wires were removed after 8 weeks in the outpatient clinic (Fig. 3A and B).This technique is especially useful in the polytraumatized patient where time is of the essence in a DCO setting, and the soft tissues will not tolerate larger incisions. Case 2: Low energy CaseA 60-year-old female with a past medical history significant for rheumatoid arthritis on biologic therapy presented to the emergency department.She thought she had sprained her ankle but presented with an avulsion-type calcaneal fracture (Fig. 4).On presentation she had a clear deformity to her calcaneus.Her skin was dark and tented.She was taken to the operating room (OR) urgently in order to prevent further skin compromise.