Calcaneal Fracture Repair Surgery

What is Calcaneal Fracture Repair Surgery

Calcaneal fracture repair surgery is a procedure to repair a broken heel bone (calcaneus). This fracture may result from having too much weight on the calcaneus, such as from a fall or car crash.

The fracture may make the calcaneus wider and shorter. The goal of calcaneal fracture repair surgery is to restore the shape and function of the calcaneus.

You may need this procedure if your calcaneus is crushed or moved out of its normal position. Depending on your injury, you may have surgery right after your injury, or you may need to wait several weeks for swelling to go down.

During the procedure, screws are used to repair the fracture and hold the bone in place. If there are only a few large bone pieces that are not far apart, the screws may be placed through small incisions in the heel (closed reduction andpercutaneous screw fixation). If the bone has been crushed or is in many pieces, wires or plates and screws may be placed through a large incision on the side of the heel (open reduction with internal fixation, ORIF). Both procedures require a long recovery period and physical therapy after surgery.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.
  • Any smoking or tobacco use.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures or organs, such as nerves, blood vessels, or tissues that connect muscle to bone (tendons).
  • Long-term stiffness, swelling, and pain (arthritis).
  • Long-term limp or heel pain.
  • Delayed wound healing.
  • Failure of the procedure.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do nottake these medicines before your procedure if your health care provider instructs you not to.

General instructions

  • You may have imaging tests, such as X-rays or a CT scan.
  • If you smoke, it is important to quit before surgery. If you need help quitting, ask your health care provider.
  • Plan to have someone take you home from the hospital or clinic.
  • If you will be going home right after the procedure, plan to have someone with you for 24 hours.
  • Arrange for someone to help you with daily activities while you recover.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
    • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
  • If your surgeon uses the closed reduction and percutaneous screw fixation method:
    • Small incisions may be made near your fracture.
    • Broken bone pieces will be put back in their original position.
    • Screws will be placed through your skin and into your bone. The screws will hold the bone pieces in a normal position for healing.
    • X-rays may be taken during the procedure to check the position of the bones and the screws.
  • If your surgeon uses the ORIF method:
    • An L-shaped incision may be made over the side of your calcaneus.
    • Your skin will be lifted away from the bone. Nerves, blood vessels, and muscle attachments will be moved out of the way.
    • Wires or plates and screws will be placed to hold the bone pieces in a normal position for healing.
  • Your incision(s) will be closed with stitches (sutures).
  • A bandage (dressing) may be applied to your incision(s).
  • A splint or cast may be placed on your foot.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • Your foot may be raised (elevated) to help reduce swelling.
  • You will be given medicine to help relieve pain as needed.
  • You may need to wear a splint or boot on your injured foot.
  • You will be given instructions about:
    • When it is safe to move your foot.
    • When it is safe to put weight on your foot.
    • When to start physical therapy exercises.
  • You may be given a walker, crutches, or a cane to help with walking.
  • Do notdrive for 24 hours if you were given a sedative.

Calcaneal Fracture Repair Surgery, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

  • Foot and ankle pain.
  • Stiffness and loss of motion.
  • Swelling.
  • Bruising.

Follow these instructions at home:

If you have a splint, cast, or boot:

  • Wear the splint, cast, or boot as told by your health care provider. Remove it only as told by your health care provider.
    • Swelling may cause your splint, cast, or boot to feel too tight. You will be shown how to adjust your splint, cast, or boot to make it feel more comfortable.
    • Do notremove any padding.
  • Do notwalk on your cast until it is hard and dry and your health care provider tells you that it is safe to walk on. It may take up to 3 days for your cast to dry, depending on the type of material that was used to make it.
  • Keep your splint, cast, or boot clean and dry. If it is not waterproof:
    • Do notlet it get wet.
    • Cover it with a watertight covering when you take a bath or a shower.
  • Do notstick anything inside your splint, cast, or boot to scratch your skin. Doing that increases your risk of infection.
  • Check the skin around your splint, cast, or boot every day. Tell your health care provider about any concerns.
  • You may put lotion on dry skin around the edges of the splint, cast, or boot. Do notput lotion, powders, or deodorant on the skin underneath the splint, cast, or boot.
  • Do nottrim rough edges from your cast unless your health care provider tells you to do that.

Bathing

  • Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • If your splint, cast, or boot is not waterproof, cover it with a watertight covering when you take a bath or a shower.
  • Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.

Check your incision area every day for signs of infection. Check for:

  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

  • If directed, put ice on your heel area.
    • If you have a removable splint, remove it as told by your health care provider.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag, or between your splint or cast and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your toes often to avoid stiffness and to lessen swelling.

Raise (elevate) your ankle above the level of your heart while you are sitting or lying down.

Activity

  • Ask your health care provider what activities are safe for you. Your health care provider will tell you when you can support your body weight (bear weight) on your heel.
  • Do physical therapy exercises as told by your health care provider.

Safety

  • Do notuse the injured limb to bear weight for 6­–12 weeks or until your health care provider says that you can. Use crutches, a walker, or a cane as told by your health care provider.
  • Remove all throw rugs, electric cords, and other tripping hazards from walkways in your house so you can move around safely.

Driving

  • Ask your health care provider when it is safe for you to drive if you have a splint, cast, or boot on your foot.
  • Do notdrive for 24 hours if you were given a medicine to help you relax (sedative) during the procedure.
  • Do notdrive or use heavy machinery while taking prescription pain medicine.

General instructions

  • Do notput pressure on any part of the splint or cast until it is fully hardened. This may take several hours.
  • Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have more redness, swelling, or pain around your incision.
  • You have more fluid or blood coming from your incision.
  • Your incision feels warm to the touch.
  • You have pus or a bad smell coming from your incision.
  • You have chills or a fever.
  • You have a splint, cast, or boot and you:
    • Have more pain than usual.
    • Have numbness or tingling in your foot.
    • Have a burning or stinging feeling under your splint or cast.
  • Your splint, cast, or boot becomes damaged.

Get help right away if:

  • You have a sudden increase in pain or swelling.
  • Your toes become very cold, blue, or numb.
  • You are not able to move your toes.

Summary

  • You will not be able to use your affected limb to support your body weight (bear weight) for several weeks.
  • Pain medicines, icing, and raising (elevating) your injured limb when sitting or lying down may help with pain relief.
  • Follow instructions from your health care provider about caring for your incision, avoiding some activities, and keeping follow-up visits.
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