title: Evaluation and treatment of open calcaneal fractures: a retrospective analysis.
abstract: The primary evaluation and management of 47 consecutive patients with 48 open calcaneal fractures was retrospectively analyzed. The fractures were treated over a 7-year period. Forty-two fractures resulted from blunt trauma, and 6 followed penetrating trauma. The predominant mechanism of injury was a motor vehicle accident. Initial treatment consisted of emergent irrigation and debridement of the open wound with intravenous antibiotic prophylaxis. Most patients underwent a second debridement. More than two thirds of the wounds were >5 cm in length, degloving-type injuries, associated with a significant neurovascular deficit and/or required a free-tissue transfer. Internal fixation of the os calcis was undertaken in 40% of patients. In addition, >40% of patients sustained concomitant foot and ankle fractures. Two patients underwent below-the-knee amputations as primary treatment. Five patients required a free-tissue transfer. Complications included two infections and one below-the-knee amputation. Two deaths occurred due to unrelated causes. Treatment standards for the optimal management of open calcaneal fractures remain controversial. A better understanding of this complex injury will help determine suitable treatment strategies.
authors.affiliation: Division of Orthopedics, University of Kentucky, Lexington, KY 40536, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lawrence
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Grau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal; D005597:Fractures, Open / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D015599:Trauma Severity Indices