A resident friend of mine was posing me this question.. how would you answer?
So, if ya could tell me which of the following is the most appropriate treatment for a Gustavo's Grade II open calcaneous fracture involving a severly comminuted lateral wall, a fractured, displaced lateral process and a Gissanes angle of 180 degrees:
a. closed casting with 12 weeks of nonweightbearing
b. open reduction with external fixation
c. open reduction, internal fixation with a DePuy titanium, lateral wall 7 hole plate and two P to A lag screws.
d. closed redution with percutaneous pinning using C-arm
BTW, the subtalar joint and calcanocuboid joints are nondisplaced. The patient did have a nonpalpable posterior tibial artery pulse on arrival but currently has a 1+ pulse after emergent splinting and elevation. Sural-plantar views are currently not available and CT with coronal, saggital, axial recons as well as 3D recons are completed but pending the damn radiologist reconstructing them and getting them on the PACS.
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