The drawing demonstrates typical positions of the five standard fragments that need reduction.
The surgical tactic that will be used identifies a step-by-step process for the reduction maneuver. Generally, one begins by identifying the “constant” fragment, i.e. the sustentacular fragment (4), which remains attached to the talus and does not displace. The reconstruction of the os calcis builds on this stable fragment and therefore one begins the reconstruction anteriorly and medially with this fragment and works simultaneously on the posterior (2) and lateral (3) articular fragments. To achieve this, it
is often necessary to apply traction to fragement 2 which helps to restore the three dimensional shape of the os calcis.
Once these are in place, one closes the lateral wall like a door, which is the final step of the reconstruction. Fragments are maintained temporarily with K-wires. The final step is the fixation.