Open calcaneal fractures: results of operative treatment

Abstract

Objective: To review our series of open calcaneal fractures compared with other series.

Design: Retrospective review.

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

Patients/participants: 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.

Intervention: 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).

Main outcome measurements: 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.