To begin, the patient had already begun to blister and bruise and had significant swelling laterally, as well as medially over the ankle. The bony prominence o the Achilles tenon attachment was tenting the skin, and was not able to be reduced in a closed fashion. Therefore, a small longitudinal Achilles incision was made directly posterior over the impinging bone. this fragment in and of itself also was a fracture split in 2, but was stabilized by the Achilles tendon. Due to the further fractures of the calcaneus on the inferior portion, partial bone was removed to debulk the bony attachment of the Achilles. At this point, under fluoroscopic imaging and after the wound had been copiously irrigated with normal saline, 3 fully threaded Steinman pins were used to reduce the Achilles insertion and hold it to the calcaneal cuboid joint, as there was no other strong joint to it. the patient had significant osteoporotic bone. At this point, the pins were left outside the skin, and the wound was closed with Prolene and a tension fashion suture with the central aspect of the subcutaneous tissue unable to be closed. Jurgan balls were placed over the steinman pins.
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