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Preoperative Planning for Calcaneal Frx

- Radiographs

- History:
    - note that age, smoking history, and diabetes are all risk factors for skin slough;

- Exam:
    - compartment syndrome
           - deep central compartment is involved most often in calcaneal frx;
           - reference:
                  - Compartment syndrome of the foot after intraarticular calcaneal fracture.
    - frx blisters:
           - usually 7-14 days is necessary for soft tissue swelling and blisters to subside (look for lateral heel skin for wrinkling);
                  - medial heel blisters are not a contraindication to surgery;
           - if persistent blisters are present beyond 2 weeks, then non operative treatment should be considered;
           - note: if surgery is to be delayed inorder to allow swelling or frx blisters to subside then ensure that an adequate closed reduction has been achieved so that displaced frx fragments do not tent the soft tissues;
                   - on occassion a patient's splint will be removed only to find that there is soft tissue necrosis from displaced frx fragments;

- Timing of Surgery:
    - realizing that mechanism usually invovles direct trauma to the heel, it is no surprise that contussion, hemorrhage, and swelling are common;
    - because of soft tissue contussion, there has be a general trend to delay surgery 7-10 days;
    - patients should be maintained w/ gentle compression wrap, and strict leg elevation;
    - patients who smoke must be urged to stop, since the incidence of wound complications is much higher in smokers

The management of soft-tissue problems associated with calcaneal fractures.

Fastest reduction of posttraumatic edema: continuous cryotherapy or intermittent impulse compression?