Name of the Procedure:

Percutaneous Skeletal Fixation of Calcaneal Fracture, with Manipulation
Common name(s): Minimally Invasive Heel Bone Fixation, Closed Reduction with Internal Fixation (CRIF) of Calcaneal Fracture

Summary

Percutaneous skeletal fixation of a calcaneal fracture is a minimally invasive surgical procedure used to repair a broken heel bone (calcaneus). Surgeons use specialized equipment to align the bone fragments and secure them with screws or pins through small incisions in the skin.

Purpose

Medical condition or problem it addresses: Calcaneal (heel bone) fractures.
Goals or expected outcomes: The procedure aims to properly align and stabilize the fractured bone, allowing it to heal correctly, improve function, and reduce pain and other complications.

Indications

• Severe displacement of the calcaneal fracture
• Fracture with significant deformity
• Inability to bear weight on the affected foot
• Persistent pain and swelling

Preparation

• Fasting for 6-8 hours before the procedure
• Adjusting or stopping certain medications as advised by the doctor
• Preoperative imaging tests like X-rays or CT scans to assess the fracture

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incisions: Small incisions are made near the heel.
3. Manipulation: The surgeon manipulates the bone fragments externally to realign them.
4. Fixation: Specialized instruments and imaging guidance (e.g., fluoroscopy) are used to insert screws or pins through the skin to stabilize the bone.
5. Closure: The small incisions are closed with sutures or surgical glue.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

Usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Radiologic technologist (if imaging assistance is required)

Risks and Complications

• Infection
• Nerve or blood vessel injury
• Nonunion or delayed healing of the fracture
• Pain or discomfort at the fixation site
• Complications related to anesthesia
• Potential need for additional surgeries

Benefits

• Faster recovery and less scarring compared to open surgery
• Stabilization of the fracture for proper healing
• Alleviation of pain and restoration of function
• Improved alignment and reduction of deformity

Recovery

• Keep the foot elevated and apply ice to reduce swelling
• Follow weight-bearing restrictions as advised by the doctor
• Physical therapy may be recommended to restore mobility
• Follow-up visits to monitor healing and remove fixation hardware if necessary
• Recovery time varies but typically spans several weeks to a few months

Alternatives

• Conservative treatment with casting and immobilization
• Open reduction and internal fixation (ORIF) which involves larger incisions
• The pros of percutaneous fixation include less invasive surgery and reduced scarring, while cons may include limited visibility for the surgeon compared to open procedures.

Patient Experience

• Patients might feel groggy or sore immediately after the procedure due to anesthesia.
• Post-operative pain can be managed with prescribed medications.
• Mild discomfort and swelling near the surgical site are common for a few days.
• Ongoing use of crutches or a walker may be needed during the initial recovery period.