Abstract
We present a novel approach to the management of patients with longstanding heel ulcers complicated by open calcaneal fractures. The principles of management of diabetic foot ulcers were combined with applied physiology of fracture healing.
Case notes of 6 consecutive patients who presented to our diabetic foot clinic between January 2009 and December 2009 were reviewed. Type of diabetes, duration of heel ulcer, type of fracture and treatment given were recorded. Initial treatment consisted of regular local debridement and application of dressing. Vacuum Assisted Continuous (VAC) pump application was deferred until 6 weeks to preserve fracture hematoma and thereby initiate fracture healing. In all patients, VAC pump was started at 6 weeks and continued till healing of ulcer to adequate depth. Infection was treated aggressively with appropriate antibiotics according to the microbiology results.
The average age was 53 (40-60) and the mean duration of follow up was 6 months. All wound healed completely, fractures united and patients returned to previous function.
An open calcaneal fracture presents a severe injury likely to be complicated by infection and consequent osteomyelitis leading to amputations. In our group of patients, a novel treatment approach consisting of multidisciplinary model resulted in successful limb preservation and return to function.
