• M Pompach, M Carda, M Amlang, and H Zwipp.
• Unfallchirurgie, Krankenhaus der Region Pardubice AG, Krankenhaus Pardubice, Pardubice, Tschechische Republik. m.pompach@gmail.com.
• Oper Orthop Traumatol. 2016 Jun 1; 28 (3): 218-30.

ObjectiveAnatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail.IndicationsAll intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma.ContraindicationsHigh perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis.Surgical TechniqueAnatomic reduction of the posterior facet using a sinus tarsi approach. Reduction and temporary fixation of the sustentacular, tuberosity, and anterior process fragments with 1.8-2.0 mm Kirschner wires. Thereafter, the C-Nail (calcaneus nail) is introduced with its guiding device stabilizing the sustentacular, tuberostity, and anterior process fragments through its three guiding arms with 6 or 7 locking screws.Postoperative ManagementPassive and active motion starts on postoperative day 2. Lymph drains help reduce swelling. Partial weightbearing with 20 kg for 6-8 weeks in the patient's own shoes is recommended. X‑ray controls are done at 4 and 8 weeks as well as after 6 and 12 months.ResultsA total of 107 calcaneal fractures treated with the C-Nail between 2011 and 2014 were evaluated according to the AOFAS score 6 months and 1 year after surgery. The measured values were on average 93.0 (range 65-100) points at 6 months and 94.1 (range 75-100) points 12 months after the surgery. Böhler's angle with initial traumatic values of 6.2° (-30 to +13°) improved postoperatively to 31.8°, after 3 months slightly decreased to 29.6°, and after 12 months to 28.3°. There were 2 cases of superficial wound necrosis (1.9 %) and 1 case a deep infection (0.93 %) with need of early C-Nail removal.

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