To The Editor:
We wish to congratulate Dr. Heier and colleagues for their contribution, “Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome” (2003;85:2276-82). Their article, detailing the management of open calcaneal fractures, provides concise and much needed guidance on a daunting orthopaedic problem. This injury has been largely ignored in the orthopaedic literature.
After reviewing the article, we were surprised by the report of a deep infection in nearly one in every five such injuries. Three recent studies have described substantially lower rates of infection1-3. Obviously, this difference may result from multiple variables, such as the number of wound débridements or the adequacy of débridement, antibiotic selection, or time to stabilization.
Heier et al. recommend a delay of definitive fixation until the wound is clean and soft-tissue swelling is minimal. In their series, fixation was undertaken at an average of 7.3 days after presentation at the hospital and the wound was “covered” at 10.6 …
Corresponding author: Keith A. Heier, MD Metrocrest Orthopedics 4780 North Josey Lane Carrollton, TX 75010
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