Outcomes of high-grade open calcaneus fractures managed with open reduction via the medial wound and percutaneous screw fixation

Abstract

Objective: To determine the clinical and functional outcomes of high-grade (types II and III) open calcaneus fractures managed with a protocol of modern wound care, open reduction via the medial hindfoot wound, and percutaneous screw fixation.

Design: Retrospective clinical series of consecutively treated patients.

Setting: Regional trauma center (level 2).

Patients/participants: Seventeen consecutive patients with open type II and III calcaneus fractures treated with fracture repair by a single surgeon.

Intervention: Soft tissue debridement and modern wound care, reduction of calcaneus fractures through the open medial wound, and percutaneous screw fixation.

Main outcome measurements: Patient demographics and injury data, radiographic analyses, complications of treatment, and hindfoot outcomes assessed with American Orthopaedic Foot and Ankle Surgeon and Maryland Foot Scores and general health with the Short Form 36 measurement at a minimum of 12 months post injury.

Results: Seventeen patients were available for follow-up at >12 months, with 15 completing all outcome measures. Four fractures were graded as type II, 9 as type IIIA, and 4 as type IIIB. There was 1 deep infection, and 1 wound dehiscence, both in type III open injuries; both were successfully treated with local wound care, delayed closure, and appropriate antibiotics. Overall, 7 of 17 (41%) patients required secondary surgical procedures, including 4 hindfoot fusions (23.5%). The average American Orthopaedic Foot and Ankle Surgeon score was 77 (range, 32-95), and the Maryland Foot Score was 64 (range, 16-93). The physical and mental components of the Short Form 36 averaged 44.4 and 49.1, respectively.

Conclusions: Limb-threatening catastrophic complications are uncommon for high-grade open calcaneus fractures treated with modern soft-tissue care, fracture reduction using the medial open fracture wound, and percutaneously placed screw fixation. Limb and whole body functional outcomes are comparable to previously published reports of both closed and open calcaneus fractures.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.