OTA 2006 Posters

Scientific Poster #41 Foot and Ankle

Open Calcaneus Fractures: Associated Complications and
Treatment Protocol
Brent Wiersema, DO (n); David Brokaw, MD (n); Telly Psaradellis, MD (n); Marcus B. Stone, PhD (n);
OrthoIndy, Indianapolis, Indiana, USA

Purpose: The literature on treating open calcaneal fractures is limited and inconsistent, with complication rates as high as 64% reported. In this retrospective study, we hypothesize that the operative treatment of open calcaneus fractures with aggressive irrigation and debridement, early provisional stabilization, and delayed definitive fixation has a complication rate that does not preclude operative management.

Methods: 755 calcaneal fractures between 1995 and 2002 were treated at our institution with 74 being open (9.8%). 67 fractures in 64 patients (39 male, 25 female; age = 32.7 ± 16.7 years; 49 with multiple injuries; follow-up = 21.5 ± 18.5 months) were retrospectively analyzed. Based on the Gustilo soft-tissue classification there were 16 grade I, 16 grade II, 16 grade IIIA, 16 grade IIIB, and 3 grade IIIC open injuries. All open fractures were treated by a similar protocol of intravenous (IV) antibiotics, emergent irrigation and debridement (I&D), initial fracture stabilization if possible, subsequent I&Ds as needed, and delayed definitive fixation. Complications were classified as superficial, deep, and amputation. A superficial infection was successfully treated with oral antibiotics and local wound care on an outpatient basis; a deep infection required operative intervention and IV antibiotics; amputation included both acute and delayed amputations.

Results: There was an overall complication rate of 21%. Eight (12%) patients had superficial wound complications, 5 (8%) had deep wound complications. Three (4%) required amputationtwo Gustilo IIIB and one Gustilo IIIC. Culture-positive osteomyelitis was seen in two (3%) patients, both grade III injuries. A medial wound was most common and seen in 36 (54%) fractures. Five patients required skin grafts, and 17 required flaps.

Conclusion/Significance: Overall, open calcaneus fractures within this institution do not have as high a complication rate as has been reported. With aggressive debridement, initial temporary fracture stabilization, and delayed definitive fixation through a standard lateral approach, the operative treatment of open calcaneus fractures with internal fixation does not put the patient at an unacceptable risk for soft-tissue and/or bony complications.

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· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.