Worsham Jacob R, Elliott Mark R, Harris Anthony M
Orthopaedic Surgery Resident, Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
Orthopaedic Surgery Resident, Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
J Foot Ankle Surg. 2016 Jan-Feb;55(1):68-71. doi: 10.1053/j.jfas.2015.06.015. Epub 2015 Aug 1.
Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of requiring subsequent amputation. The management of these injuries should include intravenous antibiotics, tetanus prophylaxis, and urgent debridement and irrigation.
开放性跟骨骨折通常是高能损伤机制所致，且常伴有其他骨科及全身系统损伤。对于医护人员而言，了解开放性骨折与闭合性骨折之间的差异至关重要，他们必须警惕伴随这种情况出现的相关损伤。我们对2003年1月至2013年1月期间在一级创伤中心就诊的62例（64处跟骨骨折）开放性跟骨骨折患者的病历进行了回顾性研究。记录了患者的性别、年龄、患侧、损伤机制、伤口情况、初始治疗以及相关损伤。最常见的损伤机制是机动车事故（35例[56.4%]）和从6英尺以上高处坠落（15例[24.1%]）。4例（6.4%）患者出现胫后动脉横断。8例（12.9%）患者发生股骨干骨折，14例（22.5%）发生同侧踝关节骨折，16例（25.8%）发生跖骨骨折，11例（17.7%）伴有中足骨折。在中足骨折患者中，12例（19.3%）发生距骨骨折，5例（8.0%）发生骰骨骨折。9例（14.5%）患者存在脊柱骨折，其中6例（9.6%）为腰椎骨折。15例（24.1%）患者伴有上肢骨折。13例（20.9%）患者伴有肺部损伤，其中8例为气胸。10例（16.1%）患者有闭合性颅脑损伤，6例（9.6%）有腹部损伤。15例（23.4%）患者接受了经皮钢丝固定治疗，7例（10.9%）接受了切开复位内固定治疗。共有44例（68.7%）骨折未进行内固定治疗。总体而言，5例（8.0%）开放性跟骨骨折患者最终接受了膝下截肢。开放性跟骨骨折是严重的高能损伤，鉴于其伴随骨科及全身系统损伤的发生率较高，患者有相当高的发病风险。III型开放性损伤后续需要截肢的风险增加。这些损伤的治疗应包括静脉使用抗生素、预防破伤风以及紧急清创和冲洗。
