ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 15 of 57
JMBS 2020, 5(1): 103–109
Clinical Medicine

Errors and Complications in Treatment of Patients with Posterior Foot Injuries

Bodnya A. I., Sukhin U. V.

Damage to the posterior part of the foot, including talus and calcaneus is about 2 % in the structure of fractures of skeleton bones. The risk of complications in their treatment remains high enough, therefore, generates a lot of contradictions and, as a consequence, research and development, aimed at preventing errors and the development of complications. The purpose of the study was to investigate the structure of errors and complications in the treatment of patients with posterior foot injuries, as well as to identify ways to eliminate them. Material and methods. A retrospective analysis of 167 patients with posterior foot bone injuries was performed. All complications that arose during the treatment and after it affected the outcomes of up to 10 years from the date of injury were identified. The results of treatment of calcaneal fractures in 124 men and 29 women (mean age – 41.2±11.7 years), talus fractures – in 11 men and 3 women (mean age – 39.7±24.2 years) were analyzed. Closed injuries of the calcaneus occurred in 105 (61.4 %) patients, open – in 66 (38.6 %), with fractures of the talus they were, respectively, 2 (12.5 %) and 12 (75 %). Among all the patients, conservative treatment was used in 107 (57.23 %) cases (plaster cast without reposition – 36, manual reposition – 71); surgical treatment in 80 (42.77 %) – submerged osteosynthesis (18), transosseous (22) and combined (31). Results and discussion. Analysis of unfavorable outcomes of treatment in patients with fractures of bones of posterior foot showed that the vast majority of complications occurred at different stages of medical care as a result of medical errors of medical-organizational (8.6 %), diagnostic (15.4 %), tactical (49.25 %) and technical (26.75 %) nature. Errors detected during the treatment of posterior foot lesions led to the development of early (34.73 %) and late (65.27 %) complications, which in 73.4 % cases were noted in conservative treatment, in operative – in 26.6 %. The survey data also indicated that one patient had several interrelated complications, and among all patients, they exceeded 2.8 times the number of complications arising from surgical treatment in the amount of conservative treatment. The difference in functional outcomes between patients after conservative and surgical treatment differed in mean values, but was not statistically significant (p>0.05). Conclusion. The most important factor in the treatment of this category of patients is the qualification of the doctor, which includes experience, his/her decision in each case and foreseeing the development of possible complications.

Keywords: posterior part of the foot, fractures, errors, complications

Full text: PDF (Rus) 211K

  1. Kalenskiy VO, Ivanov PA. The main causes of unsatisfactory outcomes of treatment for foot. Zhurnal im. NV Sklifosovskogo Neotlozhnaya meditsinskaya pomoshch. 2018; 2(7): 122-8. [Russian]
  2. Nikitin PV, Kalashnikov AV, Popov OV. Errors and complications in treatment of patients with fractures and fractures-dislocations of foot bones. Visnyk ortopedii, travmatolohii ta protezuvannia. 2004; 2(41): 75-7. [Ukrainian]
  3. Konovalchuk NS, Sorokin YeP, Lasunskiy SA, Fomichev VA, Chugaev DV. The main sources of pain in patients with consequences of calcaneal fractbres: literature review and clinical observations. Sovremennye problemy nauki i obrazovaniya. 2018; 2: 19. [Russian]
  4. Korolev MA, Yarmak DO, Miroshnikova YeA, Moldakulov ZhM, Skoroglyadov AV, Korobushkin GV. Diagnostic errors and management of foot fractures in patients with multiple or concomitant injuries. Vestnik RGMU. 2016; 3: 48-55. [Russian]
  5. Liabakh AP, Nanynets VYa, Omelchenko TM, Khomych SV. The subtalar arthrodesis in the treatment of patients with malunion calcaneus fractures. Visnyk ortopedii, travmatolohii ta protezuvannia. 2012; 2(73): 15-9. [Ukrainian]
  6. Korzh MA, Yaremenko DO, Goridova LD, Romanenko KK. Errors and complications in orthopedic and traumatological practice. Ortopediya, travmatologiya i protezirovanie. 2010; 2(579): 5-10. [Ukrainian]
  7. Wiersema B, Brokaw D, Weber T, Psaradellis T, Panero C, Weber C, et al. Musapatika сomplications associated with open calcaneus fractures. Foot Ankle Int. 2011; 32(11): 1052-7. PMID: 22338954.
  8. Griffin D, Parsons N, Shaw E, Zhu Y, Chang W, Feng C, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ. 2014; 349: g4483. PMCID: 25059747.
  9. Koski EA, Kuokkanen HO, Koskinen SK, Tukiainen EJ. Reconstruction of soft tissue after complicated calcaneal fractures. Scand J Plast Reconstr Surg Hand Surg. 2004; 38(5): 284-287. PMID: 15513600.
  10. Ulusal AE, Lin CH, Lin YT, Ulusal BG , Yazar S. The use of free flaps in the management of type IIIB open calcaneal fractures. Plast Reconstr Surg. 2008; 121(6): 2010–19. PMID: 18520889.
  11. Tang H, Han K, Li M, Zhang Q, Xie Y, Tang X, et al. Treatment of Hawkins type II fractures of talar neck by a vascularized cuboid pedicle bone graft and combined internal and external fixation: a preliminary report on nine cases. J Trauma. 2010; 69(4): 1-5. PMID: 20404755.
  12. Thornton SJ, Cheleuitte D, Ptaszek AJ, Early JS. Treatment of open intra-articular calcaneal fractures: evaluation of a treatment protocol based on wound location and size. Foot Ankle Int. 2006; 27(5): 317-23. PMID: 16701051.
  13. Worsham JR, Elliott MR, Harris AM. Open Calcaneus Fractures and Associated Injuries. J Foot Ankle Surg. 2016; 55(1): 68-71. PMID: 26243720.