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Abstract: The heel bone is the largest of the seven tarsal bones at the back of the foot. Because the heel bone is one of the major weight-bearing bones in the body, falls from height often result in fractures of the heel bone. In this case, the heel bone fracture was crushed due to a fall injury. If this fracture is not treated in time, it will lead to deformed healing of the fracture and later cause complications such as arch collapse, so the patient finally chose to be treated with surgical incision and internal fixation, after which the heel bone basically recovered in shape and recovered well from weight bearing and walking.
Basic information】Female, 24 years old
Disease Type】Heel fracture
Hospital】The First Hospital of Harbin Medical University
Date of Consultation】October 2021
Treatment plan] Decongestion treatment (local ice + elevation of the affected limb + mannitol injection intravenously) + fracture incision and internal fixation
Treatment period】Inpatient treatment for 14 days, outpatient follow-up for 3 and 6 months after surgery
Treatment effect】Fracture healing, walking back to normal
I. Initial consultation
The patient fell accidentally from the 2nd floor balcony due to the high drying rack near the balcony and the slippery ground during a clothes drying session. At the initial consultation, the patient could be seen to have obvious bruising in the heel with a tense blister, significant tenderness and pressure pain in the heel, and a localized faint palpable bone rubbing sensation. The patient was diagnosed with a fracture of the heel bone.
II. Treatment history
The patient was admitted to the hospital with severe swelling of the heel, and immediate surgery could easily lead to necrosis of the skin margin and failure of the incision to heal, so surgery could only be postponed, and the swelling was closely observed, and treatment to reduce the swelling was actively given, including local ice, elevation of the affected limb, and intravenous drip of mannitol injection. The affected blisters did not need to be picked. The swelling was significantly relieved 1 week after the injury, the blisters gradually dried up, the blister fluid was aspirated, the blister skin adhered to the skin surface, and skin folds appeared, indicating that the local skin condition improved. On the 8th day of admission, the patient was treated with fracture incision and internal fixation.
III. Treatment effect
After surgery, the patient’s incision did not show any obvious necrosis or infection, and the incision healed smoothly 14 days after surgery. At the postoperative review 3 months after surgery, the patient started to move around gradually with the help of crutches and indicated that there was no obvious pain at the heel. At the postoperative review about 6 months later, the examination showed that the fracture healed well, and the patient gradually abandoned the crutches and started to practice normal walking.
IV. Notes
We are glad that the patient resumed normal activities after the treatment, but it is more important for this patient to rehabilitate functionally after the operation, especially not too fast, but need to progress gradually. In the early stage, the patient can do isometric and isotonic lower limb muscle contraction exercises in bed to prevent muscle atrophy and lower limb vein thrombosis, and also sit on the edge of the bed to make the lower leg droop to prevent lower limb swelling caused by venous return obstruction after long-term bed rest. In addition, after the fracture recovery, it is also important to avoid strenuous exercise, and you can gradually carry out low physical activities, such as walking, to avoid affecting the fracture recovery.
V. Personal insight
The heel fracture incision is usually made through a lateral L-shaped incision in the heel, where the skin is thin and the subcutaneous area is basically right up to the bone surface, so the important prerequisite for successful surgery is the smooth healing of the wound. Since the patient came to the clinic with blisters on the heel, which means that the swelling is more serious, if the surgery is rushed at this time, it will usually lead to difficulties in closing the incision, and the stretching during the surgery will also aggravate the soft tissue damage, which will lead to large area skin necrosis if not handled properly. In order to avoid this, patients should ensure relatively good skin conditions after admission, so for heel fractures generally cannot be rushed into surgery, but need to wait for local swelling to subside and skin conditions to improve before surgery is performed.