A Study of Wound Healing in 402 Calcaneus Fracture Cases Using Precise Extensive L-Shaped Incision

Background: To investigate wound healing in 402 calcaneus fracture cases using precise extensive L-shaped incision.Method: We retrospectively analyzed 402 calcaneus fracture cases, involving patients who underwent heel bone reduction and internal fixation, using precise extensive L-shaped incision, at the second hospital of Shanxi medical university between January 2018 and December 2020. Postoperative would healing was evaluated using a self-designed skin margin grading system. Results: The patients experienced osseous healing after the surgery. A Maryland foot score of ≥90% was considered excellent. The skin margins from Grade I, II, III injuries healed spontaneously after dressing change. However, Grade IV injuries healed after debridement or removal of internal fixation.Conclusions: The precise extensive L-shaped incision, used in this study, allowed for fewer postoperative wound complications and lower incidence of skin necrosis.

Pediatric Calcaneus Fractures and Associated Injuries

Category: Trauma; Hindfoot Introduction/Purpose: The objective of the study was to determine the injuries associated with calcaneus fractures in pediatric patients and to determine if the skeletally immature sustain different injury patterns than the skeletally mature. In the adult population, these concurrent injuries are well-defined and consistent with a large axial load; however in the pediatric population, we anticipate that the differences in the mechanism of injury and developmental anatomy will alter the types of injuries observed with calcaneus fractures. Additionally, given the plasticity of immature bone, the skeletally immature patients may sustain different fracture patterns than the skeletally mature. Methods: A retrospective chart review was performed of pediatric patients presenting with a calcaneus fracture from 2008 to 2017. Patients under the age of 18 with an ICD code consistent with a calcaneus fracture were included. Patients who sustained penetrating trauma were excluded along with medical records with incomplete data. Demographics, injury information, associated injuries, skeletal maturity, fracture characteristics, and treatment were recorded. As defined by calcaneal apophyseal closure, the cohort was divided into the skeletally mature and immature for analysis. Student’s t-test and Fisher’s exact tests were used to determine significance. Results: 199 records were reviewed resulting in a sample of 81 pediatric patients with 91 calcaneus fractures. 37(40.7%) patients were immature at the time of injury. The most common mechanism witnessed was a fall in 52(64.2%) patients, with an average age of 12.8 years-old (range 0-17). There were 50(54.9%) intra-articular fractures and 15(16.5%) who underwent reduction and fixation. In the immature, open reduction internal fixation was performed on 6(14.3%) fractures which demonstrated a significantly decreased average Bohler’s angle than the conservatively treated, 14 degrees(p= 0.048). Fractures of the spine were the most commonly associated injury in 10(12.3%) pediatric patients however tibia fractures were the most commonly observed injury in the skeletally immature cohort, 7(18.9%). There were no associated injuries significantly unique to the skeletally immature. Conclusion: The present study provides one of the largest published cohorts to date of pediatric calcaneus fractures. They were most commonly associated with fractures of the spine however in the skeletally immature group as defined by apophyseal staging, tibia fractures were most often observed. No injuries were found to be significantly associated with immature patients. The skeletally immature calcanei produce fracture patterns which may be difficult to observe on radiographs and often require advanced imaging to delineate. While the majority may be treated with conservative therapy, there are no current concrete operative indications for the closed skeletally immature calcaneus fracture.

Results of Staged Treatment with External Fixation for High Energy Calcaneus Fractures

Category: Trauma; Hindfoot Introduction/Purpose: High energy calcaneus fractures have significant soft tissue compromise and typically poor outcomes. The purpose of this study was to describe patient complications and outcomes, after undergoing staged treatment for high energy calcaneus fractures, including initial treatment with medial calcaneal external fixation followed by definitive reconstruction. Methods: A retrospective chart review with prospective data was performed from April 2013 to February 2019. Inclusion criteria for the study included: patients >18 years of age, closed Sanders III and IV fractures or open fractures of the calcaneus. Patients were initially treated with placement of a medial based external fixator with closed reduction. Once the soft tissue envelope had improved, definitive fixation was performed, either ORIF or ORIF with primary subtalar fusion. Results: There were a total of 15 patients that met inclusion criteria for the study. 9 of the fractures were open and 6 were closed. The medial calcaneal external fixation (ex-fix) was placed at a mean of 2.0 (0-12) days after initial injury. The definitive procedure occurred at a mean of 23.6 (12-42) days after ex-fix placement. 11 of the patients underwent calcaneus fracture ORIF with primary subtalar (ST) fusion and 4 patients were treated with calcaneus fracture ORIF alone. 14 (93%) of the patients showed radiographic union at an average of 6.7 months. Mean PROMIS scores showed improvement in physical function, mood, and a decrease in pain at an average of 19 (5-72) months after initial injury. The average VAS pain score was 3.5 (0-7). Conclusion: A staged protocol for high-energy and open calcaneal fractures is an effective tool in treating these difficult injuries. It allows the soft tissues to improve while maintaining length and alignment of the fracture for definitive fixation and minimizing complications. There were improvements in physical function, mood, and a decrease in pain at final follow-up of almost 2 years. [Table: see text]