U Approach to Calcaneus indications:
- U Approach to Calcaneus is used for open reduction and internal fixation of Calcaneus fracture.
Position of the Patient
- Place the patient prone on the operating table.
- Support leg on sandbag.
Landmarks and Incision
- Make lateral incision as described in lateral approach to calcaneus.
- Make medial incision as described in medial approach to calcaneus.
- Connect medial and lateral incisions with a transverse posterior incision inferior to the insertion of Achilles tendon.
- This forms a U-shaped incision around the posterior four-fifths of bone.
- There is No internervous plane for the U Approach to Calcaneus.
- Divide superficial and deep fascia.
- Incise periosteum transversely in line with the incision.
- Dissect subperiosteally to create U-shaped flap consisting of skin, fatty heel pad, plantar aponeurosis and muscles.
- Elevate plantar aponeurosis and muscles off the calcaneus to expose the bone.
The structures at risk during U Approach to Calcaneus include:
- Sural nerve (lateral): it lies 18.8mm from the lateral border of the Achilles tendon at its insertion and crosses over the lateral edge of the Achilles tendon 9.8cm above the insertion.
- Medial calcaneal nerve (medial).
- Nerve to abductor digiti minimi (medial).
- Campbel’s Operative Orthopaedics book 12th