The Use of a Kickstand Modification for the Prevention of Heel Decubitus Ulcers in Trauma Patients With Lower Extremity External Fixation

Abstract

External fixation is frequently used to manage patients with lower extremity trauma. Excessive pressure from contact surfaces must be avoided to prevent added morbidity from heel ulcers. The purpose of this article is to present a simple solution to off-load the heel by adding a "kickstand" to the external fixator. The kickstand modification is designed to prevent breakdown of the soft tissue covering of the heel that can complicate the treatment of the initial injury and may also result in calcaneal osteomyelitis. By preventing such damage, the kickstand modification may also help to avoid radical procedures for soft tissue coverage, prolonged treatment times, and, ultimately, amputations. The kickstand device is made by adapting 2 extra rods and clamps to the primary external fixator to obtain proper clearance of the heel when the foot is resting over a surface. In cases where traditional off-loading devices are difficult to apply and can interfere with proper wound care, the kickstand might provide a useful preventive solution. From January to August 2006, we applied this technique in 10 patients with lower extremity trauma (11 fractures) and have seen no heel ulcers or other complications as per the staging system from the National Pressure Ulcer Advisory Panel.