Management of Compound Foot Fracture
Hospital admission is essential for patients with compound foot fractures to allow for proper surgical management, infection prevention, and comprehensive multidisciplinary care.
Initial Management
- Immediate hospitalization is necessary for all compound fractures due to the high risk of infection and complications 1
- Obtain appropriate labs including:
- Complete blood count
- Basic metabolic panel
- Coagulation studies
- Urine studies to assess renal function and hydration status
- Blood cultures if signs of infection present
Surgical Management
- Surgery within 24-48 hours significantly reduces mortality and morbidity 1
- Surgical approach includes:
- Thorough irrigation and debridement of the wound
- Removal of foreign material and devitalized tissue
- Fracture reduction and stabilization
- Consideration of external fixation for severely contaminated wounds 2
Wound Management
- Negative Pressure Wound Therapy (NPWT) is superior to standard wound dressings for compound fractures 3
- Reduces hospital stay
- Decreases number of dressings required
- Accelerates wound healing
- Lowers deep infection rates
Multidisciplinary Care
- Orthogeriatric comanagement is essential, especially in elderly patients 1, 4
- Shortest time to surgery
- Shortest length of hospital stay
- Lowest inpatient and 1-year mortality rates
Perioperative Care
Ensure adequate pain management with:
- Regular acetaminophen as foundation
- Cautious opioid use (reduced dosing in elderly)
- Consider nerve blocks for effective analgesia 4
Antibiotic prophylaxis is mandatory for all compound fractures
- Typically broad-spectrum coverage until cultures return
Prevention of Complications
Early mobilization when possible to prevent:
- Pressure ulcers
- Pneumonia
- Venous thromboembolism
Implement thromboprophylaxis with low-molecular-weight heparin 4
Regular assessment of:
- Wound status
- Neurovascular status of the extremity
- Signs of compartment syndrome
Special Considerations for Foot Fractures
- Foot fractures account for approximately one-third of lower extremity fractures 5
- For compound calcaneus fractures, consider external circular fixation with antibiotic cement spacer in severely contaminated cases 2
- Pay special attention to vascular assessment, as up to 28.2% of severe compound fractures may have major vascular injuries requiring repair 6
Rehabilitation and Follow-up
- Implement an appropriate rehabilitation program with early physical training and muscle strengthening 1
- Evaluate for risk of subsequent fractures in patients over 50 years 1
- Consider osteoporosis assessment and treatment as appropriate
Pitfalls to Avoid
- Delaying surgical debridement beyond 24-48 hours increases infection risk
- Inadequate debridement of devitalized tissue
- Failure to assess and repair vascular injuries
- Overlooking the need for tetanus prophylaxis
- Underestimating the importance of multidisciplinary care
By following this comprehensive approach with early surgical intervention, appropriate wound care, and multidisciplinary management, patients with compound foot fractures can achieve optimal outcomes with reduced risk of complications.