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Preoplateraldemonstratingjointdepressiontypeoffracture withdisplacementofatuberosityandextensionintothe calcanealcuboidjoint.The30degreesemi-coronalandaxialCATscansofthefracture.Thepatientispositionedcarefullyinthelateraldecubitus positionwithpadsundertheaxillaanddownsideperoneal nerve.Thedownlegisplacedforwardagainstandparallel withtheanterioredgeofthebed.Pillowsareplacedbetweenthelegsandenoughsheets behindthedownlegsuchthattheoperativelegliesparallelwiththegroundandatthelevelofthepatient’ship.Thewrinkletest,asdescribedbySanders,involvesdorsiflexing thefootfromaplantar-fixedpositionandlookingfornormalskin turgor,asevidencedbywrinklingoftheskinalongtheareaofthe lateralpartofthefoot.ANTERIOR ACHILLES BORDERWiththetourniquetinflated,thecorneroftheincisionisbroughtdirectlydowntobone.ABDUCTOR FASCIAInordertodissectdirectlyonthecalcaneusinasubperiosteal manner,significanttensionshouldbedevelopedbyholdingthe heelinvertedwiththethumbandpullingdirectlylaterallyaway fromthefootwithasharpretractorhelddeepintheflap.TENSIONPERONEAL TENDONSLATERALPROCESS OFTALUSPININ FIBULATUBEROSITYTUBEROSITYK-WIREK-WIREPOSTERIOR FACETTALUSThelateralx-raydemonstratingK-wireholdingthetuberosityin position.AlsonoteaK-wireintheareaoftheangleofGissane, holdingtheanterolateralfragmentreduced.Reductionoftheanterolateral fragmentisusuallyobtained byforcefulmanipulationwith eitheraballspikeorperiosteal elevator.AK-wirecanthen beplacedintheanterolateral fragmentintotheintactmedial sustentacularfragment(arrow).Thelateralwallfragmentsarepiecedbackaswellas possible,giventhattheyaresometimescomminuted.Lateralradiographandclinicalpictureaftertheanterolateralandanteriorportionofcalcaneushavebeenfixedwithlagscrews,demonstratingreductionofthefacet,theanteriorcalcaneusandthetuberosity.AftertheboneisrepositionedandheldinplacewithK-wires, itisplated.Inthisexample,twomini-fragmentplates areused.However,manyoptionsareavailablefortheplate fixation.Lateralradiographafterinitialplatefixation.Theclosureisexceedinglyimpo