Hyperbaric oxygen therapy enhances graft healing and mechanical properties after anterior cruciate ligament reconstruction: An experimental study in rabbits.

Hyperbaric oxygen therapy (HBOT) has proven successful in wound healing. However, its potential effects on anterior cruciate ligament (ACL) injuries remain uncertain. This study aimed to investigate the impact of HBOT on graft healing following ACL reconstruction in rabbits. Male New Zealand rabbits underwent ACL reconstruction and were randomly divided into two groups: the HBOT group and the ambient air group. The HBOT group received 100% oxygen at 2.5 atmospheres absolute for 2 h daily for 5 consecutive days, starting from the first day after surgery. The ambient air group was maintained in normal room air throughout the entire period. After 12 weeks following the surgery, animals were euthanized, and their knees were harvested for analysis. The HBOT group demonstrated superior graft maturation and integration in comparison to the ambient air group, as evidenced by lower graft signal intensity on magnetic resonance imaging, decreased femoral and tibial tunnel size, and higher bone mineral density values on high-resolution peripheral quantitative computed tomography scans. Additionally, biomechanical testing indicated that the HBOT group had greater load to failure and stiffness values than the ambient air group. In conclusion, the adjuvant use of HBOT improved ACL graft maturation and integration, reduced tunnel widening, and enhanced the biomechanical properties of the graft. These results may provide important insights into the potential clinical application of HBOT as a therapeutic intervention to enhance graft healing after ACL reconstruction, paving the way for further research in this area.

Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the effect of axial malalignment on graft survival after ACLR is yet to be determined. PURPOSE: To evaluate whether increased tibiofemoral rotational malalignment, namely, tibiofemoral rotation angle (TFA) and tibial tubercle-trochlear groove (TT-TG) distance, is associated with graft failure after ACLR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: In this retrospective matched control study of a single center's database, 151 patients who underwent revision ACLR because of graft failure (ACLR failure group, defined as symptomatic patients with anterior knee instability and an ACL graft tear appreciated on magnetic resonance imaging [MRI] and confirmed during arthroscopic surgery) were compared with a matched control group of 151 patients who underwent primary ACLR with no evidence of failure after ≥2-year follow-up (intact ACLR group). Patients were matched by sex, age, and meniscal injury during primary ACLR. Axial malalignment was assessed on preoperative MRI through the TFA and the TT-TG distance. Sagittal alignment was measured through the posterior tibial slope on MRI. The optimal TFA cutoff associated with graft failure was identified by a receiver operating characteristic curve. The Kaplan-Meier curve with log-rank analysis was performed to evaluate the influence of the TFA on ACLR longevity. RESULTS: The mean age was 25.7 ± 10.4 years for the ACLR failure group and 25.9 ± 10.0 years for the intact ACLR group. Among all the included patients, 174 (57.6%) were male. In the ACLR failure group, the mean TFA was 5.8°± 4.5° (range, -5° to 16°), while it was 3.0°± 3.3° (range, -3° to 15°) in the intact ACLR group (P < .001). Neither the TT-TG distance nor the posterior tibial slope presented statistical differences between the groups. The receiver operating characteristic curve suggested an optimal TFA cutoff of 4.5° for graft failure (area under the curve = 0.71; P < .001; sensitivity, 68.2%; specificity, 75.5%). Considering this a threshold, patients who had a TFA ≥4.5° had 6.6 times higher odds of graft failure compared with patients with a TFA <4.5° (P < .001). Survival analysis demonstrated a 5-year survival rate of 81% in patients with a TFA <4.5°, while it was 44% in those with a TFA ≥4.5° (P < .001). CONCLUSION: An increased TFA was associated with increased odds of ACLR failure when the TFA was ≥4.5°. Measuring the TFA in patients with ACL tears undergoing reconstruction may inform the surgeon about additional factors that may require consideration before ACLR for a successful outcome.

Medial patellofemoral ligament reconstruction in skeletally immature patients without correction of bony risk factors leads to acceptable outcomes but higher failure rates.

OBJECTIVES: To report outcomes and re-dislocation rates of medial patellar stabilizers reconstruction without bone procedures for correction of anatomical risk factors for patellar instability in skeletally immature patients; to compare isolated medial patellofemoral ligament (MPFL) reconstruction to combined MPFL and medial patellotibial ligament (MPTL) reconstruction in this population. METHODS: Patients with open physis and bone abnormalities including patella alta and/or increased tibial tubercle-trochlear groove (TT-TG) distance and/or trochlear dysplasia underwent MPFL reconstruction, either isolated or associated with MPTL reconstruction. Preoperative, 1-year follow-up and the latest follow-up (5 years minimum) data were collected. Radiological and clinical evaluations were conducted, with special attention to failure rate. Comparison of results from isolated MPFL and combined MPFL/MPTL reconstructions was performed. RESULTS: Twenty-nine patients were included, 19 in the isolated MPFL group (median 14 years old; follow-up 5.8 â€‹± â€‹1.7 years) and 10 in the combined MPFL/MPTL group (median 13.5 years old; follow-up 5.2 â€‹± â€‹1.4 years). Kujala and Tegner scores increased over time, although without statistically significant differences between the two groups at the latest follow-up (p â€‹= â€‹0.840 and p â€‹> â€‹0.999, respectively). During follow-up, 5 of 19 (26.3%) isolated MPFL and 2 of 10 (20%) MPFL/MPTL reconstructions experienced recurrence of patellar dislocation (p â€‹> â€‹0.999). Trochlear dysplasia type D (p â€‹= â€‹0.028), knee rotation (p â€‹= â€‹0.009) and lateral patellar tilt angle (p â€‹= â€‹0.003) were associated with patellar instability recurrence. The isolated MPFL group showed increased laxity on physical exam at the latest follow-up compared to the 1-year follow-up (patellar glide test (p â€‹= â€‹0.002), patellar tilt test (p â€‹= â€‹0.042) and subluxation in extension (p â€‹= â€‹0.019). This increased laxity was not observed in the MPFL/MPTL group (p â€‹> â€‹0.999). Comparing both groups, the glide test was significantly better in the combined MPFL/MPTL group in comparison to the isolated MPFL reconstruction group at the latest follow-up (p â€‹= â€‹0.021). CONCLUSION: MPFL reconstruction in isolation or combined with MPTL reconstruction in skeletally immature patients with additional uncorrected anatomical patellofemoral abnormalities leads to acceptable clinical outcomes within a minimum of 5 years follow-up, although has a high failure rate of 24.1%. Addition of a MPTL reconstruction to the MPFL may result in decreased patellar laxity on physical exams, as demonstrated by better patellar glide test, patellar tilt test and subluxation in extension. LEVEL OF EVIDENCE: Level III; retrospective cohort study.

Systematic Review of Clinical Results After Medial Meniscus Allograft Transplantation Reveals Improved Patient Reported Outcomes at Greater Than 5 Years Follow-Up.

PURPOSE: To systematically summarize the medial meniscus allograft transplantation (MAT) reported outcomes and evaluate whether the surgical technique is associated with allograft extrusion and knee function. METHODS: Systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were English-language clinical studies involving arthroscopically assisted medial MAT that reported the surgical technique and the presence of graft extrusion or functional outcomes after surgery. Studies in which outcomes for medial MAT could not be separated from lateral MAT were excluded. Surgical technique, allograft-related characteristics, and clinical outcomes were extracted. RESULTS: Twenty-four studies with 328 medial MAT were included, 58.3% studies qualified as level 4 of evidence, 29.2% as level 3, and 12.5% as level 2. Allograft fixation techniques were bone plug (235/328 [71.6%]), bone bridge/trough (55/328 [16.8%]), and soft-tissue suture fixation only (38/328 [11.6%]). Relative percentage of extrusion after surgery ranged from 24.8% to 53.7%. Major extrusion (>3 mm) ranged from zero to 78%. Overall, functional scores improved after medial MAT. None of surgical techniques were associated with poor functional outcomes or extruded meniscus; however, nonanatomical placement of the anterior and posterior horns appeared to increase meniscus extrusion. CONCLUSION: Medial MAT provides favorable outcomes, with acceptable rates of complication and failure regardless of surgical technique. Although allograft extrusion appears equivalent for both bone plug and soft-tissue fixation techniques, positioning allograft horns at the native meniscal footprint may be critical for preventing extrusion. However, the heterogeneity and low level of evidence of the studies included in this review prevent decisive conclusions regarding optimal MAT fixation techniques, clinical significance of allograft extrusion, or comparative clinical outcomes after medial MAT. LEVEL OF EVIDENCE: Level IV - systematic review of Level II to IV studies.

Quantitative alpha-defensin testing: Is synovial fluid dilution important?

BACKGROUND: Alpha-defensin has been widely studied for the diagnosis of periprosthetic joint infection (PJI). However, there is a lack of detailed information regarding the proper laboratory technique of the enzyme-linked immunosorbent assay (ELISA) method, such as sample dilution. AIM: To assess the influence of dilution in the synovial fluid during ELISA for the diagnosis of knee PJI; and determine which dilution presents a better performance. METHODS: Forty samples of synovial fluid from arthroplasty knees were included, 17 in the infected group and 23 in the aseptic group, according to Musculoskeletal Infection Society criteria. Initially, five synovial fluid samples from each group were assessed for quantitative analysis of alpha-defensin using ELISA. Different dilution ratios (1:10, 1:100, 1:500, 1:1000 and 1:5000) were tested based on the predetermined cutoff value of 5.2 mg/L. The dilutions that performed better were used to compare the results of all samples. RESULTS: For infected cases, a gradual increase in the dilution of synovial fluid samples led to an equivalent increase in alpha-defensin level. The same was not observed in the aseptic cases. Both 1:1000 and 1:5000 dilutions presented satisfactory results to differentiate infected and aseptic cases. Further analyses were performed using 1:1000 and 1:5000 for all 40 samples. The 1:1000 dilution resulted in a sensitivity of 88.2% (95%CI, 66%-98%) and specificity of 95.7% (95%CI, 79%-99%), whereas the 1:5000 dilution presented a sensitivity of 94.1% (95%CI, 73%-99%) and a specificity of 100% (95%CI, 86%-100%). CONCLUSION: The synovial fluid dilution had an important influence on the alpha-defensin ELISA results. Dilutions of 1:5000 showed the best performance for the diagnosis of knee PJI. The results of this study set the basis for a more reliable and reproducible alpha-defensin ELISA during the investigation of PJI, contributing to the expansion of this technique in different treatment centers worldwide.

Performance of alpha-defensin lateral flow test after synovial fluid centrifugation for diagnosis of periprosthetic knee infection.

BACKGROUND: The quantitative alpha-defensin enzyme-linked immunosorbent assay (ELISA) demands a prior synovial fluid centrifugation, whereas this processing is not routinely required prior to the alpha-defensin lateral flow test. AIM: To evaluate whether a prior synovial fluid centrifugation could lead the lateral flow performance to achieve comparable results to ELISA during periprosthetic joint infection (PJI) diagnosis. METHODS: Fifty-three cases were included in this study: 22 classified as PJI and 31 classified as aseptic cases, according to Musculoskeletal Infection Society 2013 criteria. Synovial fluid samples were submitted to centrifugation, and the supernatant was evaluated by ELISA and lateral flow tests. The sensitivity (SE), specificity (SP) and accuracy of each method were calculated as well as the agreement between those two methods. RESULTS: In all of the 31 samples from aseptic patients, alpha-defensin ELISA and lateral flow tests showed negative results for infection. Regarding the 22 infected patients, the lateral flow test was positive in 19 cases (86.4%) and the ELISA was positive in 21 (95.5%). Sensibility, SP and accuracy were, respectively, 86.4% (95%CI: 65.1%-97.1%), 100% (95%CI: 88.8%-100%) and 93.2% (95%CI: 82.8%-98.3%) for the lateral flow test and 95.5% (95%CI: 77.2%-99.9%), 100% (95%CI: 88.8%-100%) and 98.1% (95%CI: 89.9%-100%) for ELISA. An agreement of 96.2% between those methods were observed. No statistical difference was found between them (P = 0.48). CONCLUSION: Alpha-defensin lateral flow test showed high SE, SP and accuracy after a prior synovial fluid centrifugation, achieving comparable results to ELISA. Considering the lower complexity of the lateral flow and its equivalent performance obtained in this condition, a prior centrifugation might be added as a valuable step to enhance the PJI diagnosis.

The knee in congenital femoral deficiency and its implication in limb lengthening: a systematic review.

Congenital femoral deficiency (CFD) is a rare disorder with several limb anomalies including limb shortening and knee cruciate ligament dysplasia.Limb lengthening is usually performed to correct lower limb discrepancy. However, complications, such as knee subluxation/dislocation, can occur during this treatment.Here, we explore CFD knee abnormalities and knee dislocation during limb elongation, discussing when and whether knee ligament reconstruction prior to the lengthening would be necessary to reduce the risk of knee dislocation.There is not enough support in the literature for the routine reconstruction of cruciate ligaments in CFD patients.Of note, in cases of severe anteroposterior or posterolateral rotatory instability, cruciate ligament reconstruction might be considered to decrease the risk of knee subluxation/dislocation during the lengthening treatment. Cite this article: EFORT Open Rev 2021;6:565-571. DOI: 10.1302/2058-5241.6.200075.

ASSESSMENT OF THE USE OF TRANEXAMIC ACID AFTER TOTAL KNEE ARTHROPLASTY.

OBJECTIVE: To evaluate the profile of blood loss and blood transfusions after the introduction of Tranexamic acid (TXA) in a tertiary university hospital in Brazil. METHODS: 173 patients were retrospectively divided into two groups: the ones who received TXA and the control group. Hemoglobin levels (Hb), drain output, transfusion rates, and thromboembolic events were measured. RESULTS: Among the patients included in this study, 82 cases received TXA. Blood transfusion occurred in 3 cases of the TXA group (3.7%), and in 27 control group cases (29.7%; p < 0.001). The average Hb decrease was 2.7 g/dl (± 1.39) and the median drain output was 270 mL in the TXA group. In the control group, the values were 3.41 g/dl (± 1.34; p < 0.001) and 460 mL (p < 0.001), respectively. Thromboembolic events occurred in 2 TXA group cases (2.4%) and in 3 control group cases (3.3%; p > 0.999). CONCLUSION: TXA was effective in reducing blood transfusion rates, Hb decrease, and drain output on the 1st postoperative day without increasing thromboembolic events. Level of evidence III, Retrospective comparative study.

OBJETIVO: Avaliar o perfil de perda sanguínea e hemotransfusões após a introdução da prática do uso de ácido tranexâmico (ATX) em um serviço terciário universitário brasileiro. MÉTODOS: 173 pacientes foram separados retrospectivamente em dois grupos: uso do ATX e controle. Foram analisados valores da hemoglobina (Hb), débito do dreno, necessidade transfusional e complicações tromboembólicas. RESULTADOS: Dentre os pacientes admitidos no estudo, 82 fizeram uso do ATX. Hemotransfusão ocorreu em 3 casos do grupo ATX (3,7%) e em 27 controles (29,7%, p < 0,001). A queda de Hb teve média de 2,7 g/dl (± 1,39) e o débito do dreno, mediana de 270 ml no grupo ATX. No grupo controle, os valores foram de 3,41 g/dl (± 1,34; p < 0.001) e de 460 ml (p < 0.001), respectivamente. Eventos tromboembólicos ocorreram em 2 casos (2,4%) no grupo ATX e em 3 no controle (3,3%, p > 0.999). CONCLUSÃO: o uso do ATX foi efetivo em reduzir hemotransfusões, queda de Hb e débito drenado no 1° dia pós-operatório, sem aumentar eventos tromboembólicos. Nível de evidência III, Estudo retrospectivo comparativo.

Assessment of the use of tranexamic acid after total knee arthroplasty / Avaliação do uso do ácido tranexâmico durante a artroplastia total do joelho

ABSTRACT Objective: To evaluate the profile of blood loss and blood transfusions after the introduction of Tranexamic acid (TXA) in a tertiary university hospital in Brazil. Methods: 173 patients were retrospectively divided into two groups: the ones who received TXA and the control group. Hemoglobin levels (Hb), drain output, transfusion rates, and thromboembolic events were measured. Results: Among the patients included in this study, 82 cases received TXA. Blood transfusion occurred in 3 cases of the TXA group (3.7%), and in 27 control group cases (29.7%; p < 0.001). The average Hb decrease was 2.7 g/dl (± 1.39) and the median drain output was 270 mL in the TXA group. In the control group, the values were 3.41 g/dl (± 1.34; p < 0.001) and 460 mL (p < 0.001), respectively. Thromboembolic events occurred in 2 TXA group cases (2.4%) and in 3 control group cases (3.3%; p > 0.999). Conclusion: TXA was effective in reducing blood transfusion rates, Hb decrease, and drain output on the 1st postoperative day without increasing thromboembolic events. Level of evidence III, Retrospective comparative study.

RESUMO Objetivo: Avaliar o perfil de perda sanguínea e hemotransfusões após a introdução da prática do uso de ácido tranexâmico (ATX) em um serviço terciário universitário brasileiro. Métodos: 173 pacientes foram separados retrospectivamente em dois grupos: uso do ATX e controle. Foram analisados valores da hemoglobina (Hb), débito do dreno, necessidade transfusional e complicações tromboembólicas. Resultados: Dentre os pacientes admitidos no estudo, 82 fizeram uso do ATX. Hemotransfusão ocorreu em 3 casos do grupo ATX (3,7%) e em 27 controles (29,7%, p < 0,001). A queda de Hb teve média de 2,7 g/dl (± 1,39) e o débito do dreno, mediana de 270 ml no grupo ATX. No grupo controle, os valores foram de 3,41 g/dl (± 1,34; p < 0.001) e de 460 ml (p < 0.001), respectivamente. Eventos tromboembólicos ocorreram em 2 casos (2,4%) no grupo ATX e em 3 no controle (3,3%, p > 0.999). Conclusão: o uso do ATX foi efetivo em reduzir hemotransfusões, queda de Hb e débito drenado no 1° dia pós-operatório, sem aumentar eventos tromboembólicos. Nível de evidência III, Estudo retrospectivo comparativo.

BIOLOGICAL ENHANCEMENTS FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

The anterior cruciate ligament (ACL) is mostly responsible for providing knee stability. ACL injury has a marked effect on daily activities, causing pain, dysfunction, and elevated healthcare costs. ACL reconstruction (ACLR) is the standard treatment for this injury. However, despite good results, ACLR is associated with a significant rate of failure. In this context, the mechanical and biological causes must be considered. From a biological perspective, the ACLR depends on the osseointegration of the graft in the adjacent bone and the process of intra-articular ligamentization for good results. Here, we discuss the mechanisms underlying the normal graft healing process after ACLR and its biological modulation, thus, presenting novel strategies for biological enhancements of the ACL graft. Level of evidence III, Systematic review of level III studies.

O ligamento cruzado anterior (LCA) é um dos principais responsáveis pela estabilidade do joelho. Sua lesão gera importante prejuízo nas atividades diárias, causando dor e disfunção, com elevado custo socioeconômico. A reconstrução ligamentar é o tratamento padrão atual e, embora com bons resultados, ainda apresenta significativo índice de falhas. Nesse contexto, causas mecânicas e biológicas são consideradas. Do ponto de vista biológico, a reconstrução do LCA depende da osteointegração do enxerto no osso adjacente e do processo de ligamentização intra-articular para um bom resultado. Neste artigo, são discutidos o processo de cicatrização normal do enxerto após a reconstrução ligamentar e os mecanismos biológicos de modulação dessa cicatrização, apresentando as atuais estratégias biológicas já estudadas para otimizar esse processo. Nivel de evidência III, Revisão sistemática de estudos nível III.

Epidemiological study on calcaneus fractures in a tertiary hospital / Estudo epidemiológico das fraturas do calcâneo em um hospital terciário

ABSTRACT Objective: To analyze the epidemiology and characteristics of patients with calcaneus fractures. Methods: This is a retrospective revision of patients with calcaneus fractures hospitalized in the Institute of Orthopedics and Traumatology of this institution between 2006 and 2010. Data such as age, gender, laterality, trauma mechanism, type of fracture, associated injuries, compound fractures, and time from injury to surgery were analyzed. Results: The analysis of 52 patients showed that men were more commonly affected than women, at a ratio of 5.5:1. Bilateral fractures were observed in ten cases, resulting in a total of 62 calcaneus fractures. A fall from a height was the most frequent trauma mechanism (75%), followed by motorcycle accidents (11.5%) and automobile accidents (9.6%). The most frequent fractures were intra-articular, with 47 cases. Compound fractures were observed in 15 patients (28.9%). Non-surgical management was adopted for 11 patients while 41 patients underwent surgery. The mean time between trauma and the definitive treatment was 7.8 days (range: 0-21 days), and 58.5% of cases were treated within seven days. Conclusion: Patients with calcaneus fractures, most commonly young men, were admitted to a high complexity care hospital, victims of a fall from a height with associated injuries. The great severity of these fractures is characterized by the high prevalence of bilateral (19.2%) and compound fractures (28.9%) in this population group.

RESUMO Objetivo: Analisar a epidemiologia e as características das lesões e dos pacientes com fraturas do calcâneo. Métodos: Revisão retrospectiva dos pacientes com fraturas do calcâneo internados de 2006 a 2010, no Instituto de Ortopedia e Traumatologia dessa instituição. Foram analisados parâmetros como idade, gênero, lateralidade, mecanismo de trauma, tipo de fratura, lesões associadas, exposição e tempo decorrido até o tratamento cirúrgico. Resultados: Foram encontrados 52 pacientes com fratura do calcâneo, dez casos bilaterais (19,2%), total de 62 calcâneos fraturados, com predomínio do gênero masculino, na relação 5,5:1. A média de idade foi de 36,8 anos. O mecanismo de trauma mais frequente foi a queda de altura (75,0% dos casos), seguido por acidentes de motocicleta (11,5%) e acidentes de automóvel (9,6%). Fraturas intra-articulares foram mais frequentes, com 47 casos. Quinze pacientes apresentaram fraturas expostas (28,9%). Dos 52 pacientes com fratura do calcâneo, 11 foram tratados conservadoramente e 41, cirurgicamente. O tempo médio entre o trauma e o tratamento cirúrgico definitivo foi de 7,8 dias, variou de 0 a 21 dias, com a maioria dentro dos primeiros sete dias (58,5%). Conclusão: Pacientes com fraturas do calcâneo atendidos em um hospital voltado para o atendimento de alta complexidade foram na maioria jovens, do sexo masculino, que sofreram queda de altura e com algum tipo de lesão associada. Os índices elevados de bilateralidade (19,2%) e de exposição da fratura (28,9%) caracterizam a maior gravidade dessas fraturas nesse grupo populacional.

Epidemiological study on calcaneus fractures in a tertiary hospital.

OBJECTIVE: To analyze the epidemiology and characteristics of patients with calcaneus fractures. METHODS: This is a retrospective revision of patients with calcaneus fractures hospitalized in the Institute of Orthopedics and Traumatology of this institution between 2006 and 2010. Data such as age, gender, laterality, trauma mechanism, type of fracture, associated injuries, compound fractures, and time from injury to surgery were analyzed. RESULTS: The analysis of 52 patients showed that men were more commonly affected than women, at a ratio of 5.5:1. Bilateral fractures were observed in ten cases, resulting in a total of 62 calcaneus fractures. A fall from a height was the most frequent trauma mechanism (75%), followed by motorcycle accidents (11.5%) and automobile accidents (9.6%). The most frequent fractures were intra-articular, with 47 cases. Compound fractures were observed in 15 patients (28.9%). Non-surgical management was adopted for 11 patients while 41 patients underwent surgery. The mean time between trauma and the definitive treatment was 7.8 days (range: 0-21 days), and 58.5% of cases were treated within seven days. CONCLUSION: Patients with calcaneus fractures, most commonly young men, were admitted to a high complexity care hospital, victims of a fall from a height with associated injuries. The great severity of these fractures is characterized by the high prevalence of bilateral (19.2%) and compound fractures (28.9%) in this population group.

OBJETIVO: Analisar a epidemiologia e as características das lesões e dos pacientes com fraturas do calcâneo. MÉTODOS: Revisão retrospectiva dos pacientes com fraturas do calcâneo internados de 2006 a 2010, no Instituto de Ortopedia e Traumatologia dessa instituição. Foram analisados parâmetros como idade, gênero, lateralidade, mecanismo de trauma, tipo de fratura, lesões associadas, exposição e tempo decorrido até o tratamento cirúrgico. RESULTADOS: Foram encontrados 52 pacientes com fratura do calcâneo, dez casos bilaterais (19,2%), total de 62 calcâneos fraturados, com predomínio do gênero masculino, na relação 5,5:1. A média de idade foi de 36,8 anos. O mecanismo de trauma mais frequente foi a queda de altura (75,0% dos casos), seguido por acidentes de motocicleta (11,5%) e acidentes de automóvel (9,6%). Fraturas intra-articulares foram mais frequentes, com 47 casos. Quinze pacientes apresentaram fraturas expostas (28,9%). Dos 52 pacientes com fratura do calcâneo, 11 foram tratados conservadoramente e 41, cirurgicamente. O tempo médio entre o trauma e o tratamento cirúrgico definitivo foi de 7,8 dias, variou de 0 a 21 dias, com a maioria dentro dos primeiros sete dias (58,5%). CONCLUSÃO: Pacientes com fraturas do calcâneo atendidos em um hospital voltado para o atendimento de alta complexidade foram na maioria jovens, do sexo masculino, que sofreram queda de altura e com algum tipo de lesão associada. Os índices elevados de bilateralidade (19,2%) e de exposição da fratura (28,9%) caracterizam a maior gravidade dessas fraturas nesse grupo populacional.