Sanders type III calcaneal fracture fixed with a locking angular plate: A case report

Abstract

Introduction. The calcaneus is a tarsal bone which plays a major role in transferring weight from the lower leg down through the ankle joint onto the forefoot and toes. It participates in the formation of the outer and inner longitudinal arch of the foot and has a significant role in walking and transferring body weight. Calcaneal fractures most often occur by jumping, falling from a height, or less often, in traffic accidents. Calcaneal fractures can be extra-articular and intra-articular. Intra-articular fractures can entirely damage joint surfaces, which results in deformity and immobility of the foot. They can be extra-articular and intraarticular, when disruption of the entire articular surfaces, deformity, and weakness of the foot occur. Case report. This case report presents a 40-year-old male with an intra-articular calcaneal fracture. He was injured by falling from a height of 3 meters and sustained an intra-articular fracture type IIIAB where one fracture line went laterally and the other centrally over the posterior calcaneal facet. Surgery was performed on the sixth day after the injury. The prepared locking plate for calcaneus was adapted and fixed with spongy screws in relatively preserved joint fragments: sustentaculum tali, tuberositas lateralis calcanei and tuber calcanei. In this way, we ensured the position of the repaired fragments, and then we placed 4 more spongy screws inside the healthy bone tissue, which was enabled with the use of this plate. With this procedure, the calcaneal axis, i.e. the varus deformity, height, width, length and angles of the bone (Bohler's and Gissane's angle) were corrected. From day one, the patient started to move his toes, and on the third day the patient started to move the ankle and began to walk with the help of props with no support on the leg. Conclusion. The preoperative value of Bohler's angle is a significant correlation between the severity of the injury and displacement of fragments in intra-articular calcaneal fractures. The goal of the surgery was to restore the posterior calcaneal articular facet, avoid soft tissue infection and form a normal shape and position of a foot.