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Open hindfoot injuries.

Steven J Lawrence1, Manuj Singhal

  • 1Department of Orthopaedic Surgery, University of Kentucky, Lexington 40536-0284, USA.

The Journal of the American Academy of Orthopaedic Surgeons
|June 6, 2007
PubMed
Summary
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Managing open hindfoot injuries like talar and calcaneal fractures is complex due to severe trauma and soft-tissue damage. Optimal outcomes require precise reduction, timely intervention, infection control, and careful tissue management, though complications are common.

Area of Science:

  • Orthopaedic Surgery
  • Trauma Care

Background:

  • Open talar and calcaneal injuries present significant challenges in hindfoot trauma management.
  • High-energy mechanisms often result in extensive soft-tissue disruption, fracture comminution, and cartilage damage.
  • Talar injuries frequently involve osteonecrosis, while calcaneal fractures can be highly comminuted.

Purpose of the Study:

  • To review the complexities and management strategies for open hindfoot injuries.
  • To identify key variables influencing successful outcomes in acute and reconstructive phases.
  • To discuss common complications and long-term sequelae.

Main Methods:

  • Review of current literature on open talar and calcaneal hindfoot fractures.
  • Analysis of treatment phases: acute management and reconstructive procedures.

Related Experiment Videos

  • Evaluation of factors affecting prognosis and patient outcomes.

    • Main Results:

    • Successful management hinges on accurate fracture reduction, appropriate timing, infection prevention, and meticulous soft-tissue handling.
    • Anatomic reconstruction is often not feasible, leading to common sequelae like joint stiffness and posttraumatic arthritis.
    • Devastating complications such as infection and osteonecrosis can occur, impacting long-term results.

    Conclusions:

    • Long-term outcomes for open hindfoot injuries are frequently unsatisfactory, with potential for chronic ambulatory dysfunction and neurogenic pain.
    • Despite optimal management, severe cases with extensive soft-tissue injury may necessitate limb amputation.
    • Effective treatment requires a comprehensive approach addressing fracture severity, soft-tissue status, and potential complications.