Most calcaneal fractures occur in male industrial workers, making the economic importance of this injury substantial. Many authors have reported that patients may be totally incapacitated for as long as three years and partially impaired for as long as five years after the injury1,11,39,73,94,133. Although modern operative intervention has improved the outcome in many patients, there still is no real consensus on classification, treatment, operative technique, or postoperative management. In this article, the current thinking regarding the treatment of these very difficult fractures will be reviewed.

As early as 1908, Cotton and Wilson suggested that open reduction of a calcaneal fracture was contra-indicated27. McLaughlin agreed, likening attempts at operative fixation to the “nailing of a custard pie to the wall.”76 Cotton and Wilson recommended closed treatment with use of a medially placed sandbag, a laterally placed felt pad, and a hammer to reduce the lateral wall and “reimpact” the fracture27. Although initially they were enthusiastic about this technique, by the 1920s they had abandoned the treatment of acute fractures altogether and had turned instead to the treatment of healed malunions29.

Despite the fact that Bohler11 advocated open reduction in 1931, the principal reasons for the predominance of nonoperative treatment were the technical problems associated with operative treatment. Anesthesia was not always effective, radiography and fluoroscopy were not well developed, antibiotics did not exist, and a sound understanding of the principles of internal fixation was lacking105. The resulting complications of infection, malunion, and nonunion, and the possible need for amputation, made most surgeons believe that treatment should be nonoperative.

In 1935, Conn, who was dissatisfied with standard treatment methods, reported on the use of delayed primary triple arthrodesis, with …

Displaced intra-articular fractures of the calcaneus.

Pilon Fractures: Assessment and Treatment

Objectives:To evaluate patient outcomes after treatment of lower-extremity fractures associated with blister formation and to assess complications after soft-tissue treatment using a prospective protocol.Design:Retrospective evaluation of prospectively collected data.Setting:Level I trauma center.Pa

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Blisters associated with lower-extremity fracture: results of a prospective treatment protocol.

Acute compartment syndrome: Cause, diagnosis, and new viewpoint.

The most frequent postoperative complications after an ankle fracture are usually skin related. We present the results of a retrospective study of 112 patients with ankle fracture who had undergone open reduction and internal fixation from January 2014 to December 2014. The following features were analyzed: patient comorbidities, fracture type, the presence of an open fracture or fracture-dislocation, timing and duration of surgery, preoperative glucose level, and short-term complications (i.e., blisters, wound dehiscence, deep and superficial infections, and reintervention). The mean age of the patients was 50.38 years. Fracture blisters were present in 20.5% of the cases. The operative time was 75.74 ± 25.09 minutes for patients with blisters and 64.48 ± 19.73 minutes for patients without blisters (p = .023). The preoperative blood glucose levels were 122.96 ± 28.46 g/dL in the patients with blisters and 106.70 ± 21.32 g/dL in the patients without blisters (p = .003). No statistically significant differences were observed between the patients who had undergone surgery 24 hours after injury. In conclusion, the presence of postoperative blisters in patients with ankle fractures was associated with prolonged surgical procedures and high serum glucose levels.

Blisters in Ankle Fractures: A Retrospective Cohort Study.

A biomechanical study was performed to examine a proposed mechanism of fracture blister formation. Sixty cadaver ankle skin specimens were subjected to several levels of uniaxial strain and examined histologically. Dermal-epidermal separation patterns similar to those found histologically in previous studies of biopsied fracture blisters were seen in specimens strained 152% and greater. These findings support the hypothesis that fracture blisters can result from strain developed in the skin during initial fracture deformation.

David Scott

Papers

Fracture Blister Formation: A Laboratory Study