BACKGROUND: Open calcaneal fractures are devastating, high-energy injuries frequently occurring in multiply-injured patients. Unsatisfactory outcomes with significant complications rates are frequently reported. Our purpose was to assess outcomes of delayed ORIF for open calcaneal fractures with medial hindfoot wounds and limited posterior facet comminution. MATERIALS AND METHODS: Following acute management of the open fractures, seven patients were determined to have stable medial hindfoot wounds and posterior facet comminution of three or fewer fracture fragments. The average age was 32.5 years. These patients were treated with operative management with a plate-and-screw construct using the extensile lateral approach. RAND-36 Item Health, AOFAS Ankle-Hindfoot Survey, and physical examinations were undertaken to access outcomes. RESULTS: All open calcaneal injuries were initially treated with irrigation and debridement, intravenous antibiotics, and plaster immobilization. Definitive fixation was performed at an average of 11.7 days. Six of seven patients were multiply injured. Prior to injury, five were employed on a full-time basis. Four returned to their original or a comparable job. The results of the RAND-36 Item Health Survey and the AOFAS Ankle-Hindfoot scores were 56.7 and 71, respectively. There were no postoperative infections. No patients required additional operative hindfoot procedures. Five continued to use tobacco products. None reported chronic narcotic usage. CONCLUSION: Aggressive treatment of select open calcaneal fractures with delayed ORIF produced satisfactory functional results. Most patients were able to return to gainful employment. There were no infections or wound complications.
BACKGROUND:Open calcaneal fractures are devastating, high-energy injuries frequently occurring in multiply-injured patients. Unsatisfactory outcomes with significant complications rates are frequently reported. Our purpose was to assess outcomes of delayed ORIF for open calcaneal fractures with medial hindfoot wounds and limited posterior facet comminution. MATERIALS AND METHODS: Following acute management of the open fractures, seven patients were determined to have stable medial hindfoot wounds and posterior facet comminution of three or fewer fracture fragments. The average age was 32.5 years. These patients were treated with operative management with a plate-and-screw construct using the extensile lateral approach. RAND-36 Item Health, AOFAS Ankle-Hindfoot Survey, and physical examinations were undertaken to access outcomes. RESULTS: All open calcaneal injuries were initially treated with irrigation and debridement, intravenous antibiotics, and plaster immobilization. Definitive fixation was performed at an average of 11.7 days. Six of seven patients were multiply injured. Prior to injury, five were employed on a full-time basis. Four returned to their original or a comparable job. The results of the RAND-36 Item Health Survey and the AOFAS Ankle-Hindfoot scores were 56.7 and 71, respectively. There were no postoperative infections. No patients required additional operative hindfoot procedures. Five continued to use tobacco products. None reported chronic narcotic usage. CONCLUSION: Aggressive treatment of select open calcaneal fractures with delayed ORIF produced satisfactory functional results. Most patients were able to return to gainful employment. There were no infections or wound complications.
Authors: Adam J Bevevino; Jonathan F Dickens; Benjamin K Potter; Theodora Dworak; Wade Gordon; Jonathan A Forsberg Journal: Clin Orthop Relat Res Date: 2014-10 Impact factor: 4.176