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Treatment of Complex Calcaneal Fractures with Bony Defects from Land Mine Blast Injuries with a Circular External Fixator

Four calcanei, which were massively destroyed as a result of blasting injuries from land mines, and 18 severely comminuted calcaneal fractures with bony defects (in one patient, both feet), also from land mines, were treated using a circular external fixator for reconstruction by osteogenic distraction. Because of the severe destruction of tissue to be treated, definitive orthopaedic treatment was delayed for 3 to 28 months (average, 10.1 months) after injury. Time from first use of the circular external fixator to removal of the apparatus ranged from 110 to 175 days (average, 143.7 days). Mean follow-up was 18 months. Of the 22 calcaneal injuries, 4 had excellent results, 11 good, 5 fair, and 2 had poor results. Better results were achieved in cases with lesser defects in bone and where definitive orthopaedic treatment was delayed until problems in soft tissue could be treated.