2
Introduction The treatment of calcaneal fractures affecting the ankle joint continues to be a challenge for orthopedic surgeons. The inconsistent clinical results and frequent complications of open reduction have resulted in a number of different surgical approaches to these injuries. Among calcaneal fractures, between 70% and 90% affect the subtalar joint and are caused by high-force trauma. The typical patient is a male of working age who has suffered an accident at work. Patient 54 year-old male, who presented with a comminuted fracture of the calcaneus, resulting from a work accident. Treatment Surgical treatment is performed with the following objectives: 1) To restore articular congruency. 2) To restore the height of the heel. 3) To reduce the width of the calcaneus. 4) To decompress the medial and lateral channels. 5) To obtain good axial alignment. Significant hemorrhagic exudate can develop following this type of injury, and if not completely drained, can lead to the formation of a hematoma and ultimately wound dehiscence. With the objective of reducing the likelihood of this complication occurring, PICO Single Use Negative Pressure Wound Therapy (NPWT) was utilised. It was applied in the operating room and an elastic compression bandage added once the surgery was completed. PICO works at a constant negative pressure of 80 mmHg (nominal) for up to 7 days of treatment. The first dressing change was prescribed after 48 hours. Follow-up / Results Forty-eight hours after the surgery, the compression bandage was removed and the PICO dressing evaluated. It was observed that the dressing was full, with a bluish-black color, indicative of the site’s drainage. As can be seen, the incision shows very good color with contracted, vascularized edges. There was no sign of hematoma, due to the active draining function carried out by the PICO system. No clinical signs of infection were observed. The wound was cleaned with saline solution and a second PICO dressing applied. Five days post-surgery, the dressing shows minimum exudate present. The incision site was observed and showed good progression towards healing, with contracted, vascularized edges; the perilesional skin and edges did not show signs of maceration or necrosis. No signs of infection were observed. The Single Use Negative Pressure Wound Therapy was replaced with a conventional dressing until the sutures were removed. View of Calcaneus Authors: Francisco Chaqué Asensi. Traumatologist Trauma Unit, Hospital Fremap (Seville) Dolores Gonzalez Fernández, Joaquín Cosano Montes Nurse, Paco Machota de la Corte Nurse Clinical Dept., Wound Recovery, Smith & Nephew, S.A. Prevention of local post-surgical complications in calcaneal surgery, using PICO Single Use Negative Pressure Wound Therapy Removal of calcaneus bone fragments Radiological confirmation Application of bone fragments Placement of plate specific for calcaneus
