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 sites 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 Chaqu Asensi. Traumatologist Trauma Unit, Hospital Fremap (Seville) Dolores Gonzalez Fernndez, Joaqun 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
Conclusions
The use of the PICO Single Use NPWT for prevention of surgical site complications
yielded the following benefits:
- Facilitation of rapid drainage and prevention of hematoma formation which is
common following this kind of injury.
- Near complete healing of the incision in less time (5 days) without complications.
- Good patient quality of life.
- Prevention of complication associated costs.
- Decrease of workload.
The use of PICO to manage the incision line following this type of procedure and
the resulting reduction in the incidence of complications such as haematomas,
may signify a considerable improvement in the clinical results obtained. In this
indication PICO was shown to be a cost-effective system.
09/01/12 Application of PICO
09/03/12 PICO after 48 hours
Image of the lesion 48 hours after the surgery
09/06/12 PICO after 5 days
09/06/12 Progression of lesion after 5 days.
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Smith & Nephew September 2013
45180
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