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[1/6] Calcaneus avulsion with a throwback for me personally. Technically Sanders 2, but more apt classification is Beavis (minus Butthead...) This is beavis 2 “beak” fracture, emergency. CT sums up my feelings on the matter. If you miss this, resultant wound carries 29% amp rate.
![[1/6] Calcaneus avulsion with a throwback for me personally. Technically Sanders 2, but more apt classification is Beavis (minus Butthead...) This is beavis 2 “beak” fracture, emergency. CT sums up my feelings on the matter. If you miss this, resultant wound carries 29% amp rate.](https://pbs.twimg.com/media/EWZOHz2XgAMZi7_.jpg "[1/6] Calcaneus avulsion with a throwback for me personally. Technically Sanders 2, but more apt classification is Beavis (minus Butthead...) This is beavis 2 “beak” fracture, emergency. CT sums up my feelings on the matter. If you miss this, resultant wound carries 29% amp rate.")
[2/6] Bone was osteoporotic and I have seen these fall apart when you try to manipulate them percutaneously, tines just go through it. So I made a small lateral incision (green) and gently got the fragment back in place with freer, and then held with clamps.
![[2/6] Bone was osteoporotic and I have seen these fall apart when you try to manipulate them percutaneously, tines just go through it. So I made a small lateral incision (green) and gently got the fragment back in place with freer, and then held with clamps.](https://pbs.twimg.com/media/EWZOINkXQAAL0FQ.jpg "[2/6] Bone was osteoporotic and I have seen these fall apart when you try to manipulate them percutaneously, tines just go through it. So I made a small lateral incision (green) and gently got the fragment back in place with freer, and then held with clamps.")
[3/6] One screw went in fine (from perc superior-posterior incision), but despite being gentle posterior aspect fragmented and was not able to be held. The pieces were pushing outward on skin and I removed them (“cored them out” without releasing soft tissue) to ease pressure.
![[3/6] One screw went in fine (from perc superior-posterior incision), but despite being gentle posterior aspect fragmented and was not able to be held. The pieces were pushing outward on skin and I removed them (“cored them out” without releasing soft tissue) to ease pressure.](https://pbs.twimg.com/media/EWZOIruXQAQk8Z7.jpg "[3/6] One screw went in fine (from perc superior-posterior incision), but despite being gentle posterior aspect fragmented and was not able to be held. The pieces were pushing outward on skin and I removed them (“cored them out” without releasing soft tissue) to ease pressure.")
[4/6] Because I didn’t think 1 screw was enough, I used a lateral hook miniplate to counteract tension forces (red) and get more fixation in fragment. This was casted in slight plantarflexion. For another cool technique to protect skin, read for free here: https://journals.sagepub.com/doi/pdf/10.1177/2473011417712185
![[4/6] Because I didn’t think 1 screw was enough, I used a lateral hook miniplate to counteract tension forces (red) and get more fixation in fragment. This was casted in slight plantarflexion. For another cool technique to protect skin, read for free here: https://journals.sagepub.com/doi/pdf/10.1177/2473011417712185](https://pbs.twimg.com/media/EWZOJwMWAAAyWVe.jpg "[4/6] Because I didn’t think 1 screw was enough, I used a lateral hook miniplate to counteract tension forces (red) and get more fixation in fragment. This was casted in slight plantarflexion. For another cool technique to protect skin, read for free here: https://journals.sagepub.com/doi/pdf/10.1177/2473011417712185")
![[4/6] Because I didn’t think 1 screw was enough, I used a lateral hook miniplate to counteract tension forces (red) and get more fixation in fragment. This was casted in slight plantarflexion. For another cool technique to protect skin, read for free here: https://journals.sagepub.com/doi/pdf/10.1177/2473011417712185](https://pbs.twimg.com/media/EWZOJ1WXgAEsrXq.jpg "[4/6] Because I didn’t think 1 screw was enough, I used a lateral hook miniplate to counteract tension forces (red) and get more fixation in fragment. This was casted in slight plantarflexion. For another cool technique to protect skin, read for free here: https://journals.sagepub.com/doi/pdf/10.1177/2473011417712185")
![[4/6] Because I didn’t think 1 screw was enough, I used a lateral hook miniplate to counteract tension forces (red) and get more fixation in fragment. This was casted in slight plantarflexion. For another cool technique to protect skin, read for free here: https://journals.sagepub.com/doi/pdf/10.1177/2473011417712185](https://pbs.twimg.com/media/EWZOJ1eX0AUr6Ky.jpg "[4/6] Because I didn’t think 1 screw was enough, I used a lateral hook miniplate to counteract tension forces (red) and get more fixation in fragment. This was casted in slight plantarflexion. For another cool technique to protect skin, read for free here: https://journals.sagepub.com/doi/pdf/10.1177/2473011417712185")
[5/6] Interestingly enough, I didn’t come up with the idea on my own. I saw my mentor do something similar for one of these years ago that had failed initial fixation— and the case made it into The Binder. It’s still there, and I now updated the entry with my own new annotations.
![[5/6] Interestingly enough, I didn’t come up with the idea on my own. I saw my mentor do something similar for one of these years ago that had failed initial fixation— and the case made it into The Binder. It’s still there, and I now updated the entry with my own new annotations.](https://pbs.twimg.com/media/EWZOKfhXkAAmsFC.jpg "[5/6] Interestingly enough, I didn’t come up with the idea on my own. I saw my mentor do something similar for one of these years ago that had failed initial fixation— and the case made it into The Binder. It’s still there, and I now updated the entry with my own new annotations.")
[6/6] If you’re wondering why the construct looks so familiar, turn it sideways... and now it makes more sense. 
Same idea, same screw configuration... biomechanical principles work everywhere! For more on these fractures, read here: https://pubmed.ncbi.nlm.nih.gov/18670282/
![[6/6] If you’re wondering why the construct looks so familiar, turn it sideways... and now it makes more sense. Same idea, same screw configuration... biomechanical principles work everywhere! For more on these fractures, read here: https://pubmed.ncbi.nlm.nih.gov/18670282/](https://pbs.twimg.com/media/EWZOK3PXgAArh9F.jpg "[6/6] If you’re wondering why the construct looks so familiar, turn it sideways... and now it makes more sense. Same idea, same screw configuration... biomechanical principles work everywhere! For more on these fractures, read here: https://pubmed.ncbi.nlm.nih.gov/18670282/")
Same idea, same screw configuration... biomechanical principles work everywhere! For more on these fractures, read here: https://pubmed.ncbi.nlm.nih.gov/18670282/
Addendum: my PA and I texted about this thread, and I’d like to say she deserves much of the credit. It really was a beautiful splint. 
