Open calcaneal fractures: results of operative treatment.
OBJECTIVE
To review our series of open calcaneal fractures compared with other series.


METHODS
Retrospective review.


METHODS
All patients were treated at a single Level 1 trauma center.


METHODS
We reviewed 19 consecutive patients, each with an open fracture of the calcaneus. Fracture morphology ranged from Sanders type II to type IV; associated soft tissue injuries were variable, ranging from Gustilo type I to type IIIC.


METHODS
All patients were treated with intravenous antibiotics, tetanus prophylaxis, and immediate and repeat irrigation and debridement. Definitive fracture reduction was performed at an average of 7 days after injury (range 0-22 days). Fixation methods included lateral plate and screws (11), Kirschner wires and/or screws (6), or none (2).


METHODS
AOFAS ankle-hindfoot scores, clinical examination, and radiographs.


RESULTS
All 19 patients were available for follow-up with a physical examination and radiographs at an average of 26.2 months. The AOFAS ankle-hindfoot scores averaged 81.6 (range 58-94). Five patients required free tissue transfer for wound coverage. Two patients developed chronic, draining calcaneal osteomyelitis, for which one patient underwent a below-knee amputation. In our series, for the patients with Gustilo type II and type III open calcaneal fractures, there was an 11% complication rate with higher than expected health-related quality-of-life indices.


CONCLUSIONS
Our findings do not reflect as high a complication rate for open calcaneal fractures as previously reported. We support previous claims that definitive hardware placement at the time of initial irrigation and debridement probably is not warranted: Definitive fracture stabilization can and should wait until soft tissue coverage is fully assessed.
Aldridge
Julian M
JM
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Easley
Mark
M
Nunley
James A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002111:Calcaneus / Q000293:injuries*; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005597:Fractures, Open / Q000145:classification / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis; D011183:Postoperative Complications; D012189:Retrospective Studies; D014193:Trauma Centers; D014946:Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents