Case study: Calcaneal fracture

Case presentation

A 45-year-old male patient arrived at the emergency room in severe pain, exhibiting a deformed right heel following a fall from a ladder. X-ray imaging confirmed the presence of a calcaneal fracture. Due to the complex nature of the fracture, surgical intervention was recommended.

Nerve block techniques

The calcaneus fracture repair was performed under a popliteal and adductor canal block.

• Popliteal block: A high-frequency linear transducer was used to identify the sciatic nerve sheath in the popliteal fossa. A 22-gauge needle was advanced out-of-plane under ultrasound guidance to administer 15 mL of 1% ropivacaine into the sciatic nerve sheath between the tibial and common peroneal nerves. 

Reverse Ultrasound Anatomy for a popliteal block with needle insertion out-of-plane. The local anesthetic spread is shown in blue. TN, tibial nerve; CPN, common peroneal nerve; PA, popliteal artery; PV; popliteal vein; SmM, semimembranosus muscle; BFM, biceps femoris muscle.

• Adductor canal block: After identifying the saphenous nerve in the adductor canal, 5 mL of 1% ropivacaine was injected for tourniquet pain management. The tourniquet was positioned just below the knee for the surgical procedure.

Reverse Ultrasound Anatomy for an adductor canal block with needle insertion in-plane. The local anesthetic spread is shown in blue. SaN, saphenous nerve; FA, femoral artery; FV, femoral vein; SaM, sartorius muscle; VMM, vastus medialis muscle; ALM, adductor longus muscle; AMM, adductor magnus muscle.

Patient outcome

The combination of the popliteal and adductor canal blocks served as a complete anesthetic and postoperative analgesia in this patient. The patient reported minimal pain in the immediate postoperative period with a pain score of 1-2/10. The surgery itself proceeded smoothly, without any complications. Early postoperative mobilization was encouraged and showed good progress.

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