U Approach to Calcaneus

The U Approach to calcaneus bone is indicated for open reduction and internal fixation of the 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.

Internervous plane

• There is No internervous plane for the U Approach to Calcaneus.

Deep dissection

• 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.

Dangers

The structures at risk during U Approach to Calcaneus include:

1. 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.
2. Medial calcaneal nerve (medial).
3. Nerve to abductor digiti minimi (medial).

References

• Campbel’s Operative Orthopaedics book 12th