Department of Orthopaedic Surgery, Orthopaedic Trauma Service, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
J Orthop Trauma. 2010 Mar;24(3):142-7. doi: 10.1097/BOT.0b013e3181b5c0a4.
To assess the results of a standardized staged treatment strategy for displaced open calcaneal fractures with medial wounds.
Retrospective case series.
Level I trauma center.
PATIENTS/PARTICIPANTS: Fourteen displaced open Type II or Type IIIA Orthopaedic Trauma Association (OTA) 73 Type B or C calcaneal fractures treated between January 2000 and December 2007 who were managed with a standardized regimen.
Patients were treated in a staged fashion with antibiotics, irrigation, débridement, and percutaneous Kirschner wire fixation followed by definitive open reduction and internal fixation when soft tissues were amenable to fixation.
Data regarding demographics, injury characteristics, time to fixation, interventions, and treatment complications were documented. The complication rate, time to bony union, and additional procedures were determined.
There were four OTA 73B and 10 OTA 73C injuries with open Type II or Type IIIA wounds on the medial side. All patients had débridement, irrigation, and percutaneous fixation within 8 hours of presentation. Definitive fixation was carried out on average 18 days after initial presentation with 10 patients only requiring the initial débridement and stabilization procedure followed by definitive fixation All 14 patients underwent definitive fixation through an extensile lateral approach. A superficial infection developed in one patient and a deep infection in one patient. All patients went on to union at an average follow up of 19 months.
Open Type II and IIA wounds associated with displaced OTA Type 73 B or C calcaneal fractures represent high-energy injuries with potential increased risk for wound complications. In our series, a staged treatment strategy consisting of urgent débridement, provisional internal stabilization, and late definitive reconstruction offers a protocol that may reduce infections associated with open calcaneal fractures.
评估伴有内侧伤口的移位开放性跟骨骨折的标准化分期治疗策略的结果。
回顾性病例系列。
一级创伤中心。
患者/参与者：2000 年 1 月至 2007 年 12 月期间，采用标准化方案治疗的 14 例移位开放性 II 型或 IIIA 型 Orthopaedic Trauma Association（OTA）73 型 B 或 C 跟骨骨折患者，这些患者患有开放性 II 型或 IIIA 型内侧伤口。
患者采用分期治疗，包括抗生素、冲洗、清创和经皮克氏针固定，然后在软组织可固定时进行确定性切开复位和内固定。
记录患者的人口统计学、损伤特征、固定时间、干预措施和治疗并发症等数据。确定并发症发生率、骨愈合时间和额外手术。
有 4 例 OTA 73B 和 10 例 OTA 73C 损伤，内侧有开放性 II 型或 IIIA 型伤口。所有患者在就诊后 8 小时内均行清创、冲洗和经皮固定。首次就诊后平均 18 天进行确定性固定，10 例患者仅需初次清创和稳定手术，然后进行确定性固定。所有 14 例患者均通过广泛外侧入路进行确定性固定。1 例患者发生浅表感染，1 例患者发生深部感染。所有患者在平均 19 个月的随访中均愈合。
伴有移位 OTA 73B 或 C 型跟骨骨折的开放性 II 型和 IIA 型伤口代表高能损伤，有增加伤口并发症的潜在风险。在我们的系列中，由紧急清创、临时内部稳定和晚期确定性重建组成的分期治疗策略提供了一种方案，可降低与开放性跟骨骨折相关的感染。
