A 40-year-old woman with a closed calcaneal fracture develops tense serous-filled blisters over the hindfoot 36 hours after injury. Definitive open reduction is best managed by:
- A Immediate surgery through the blistered skin since the fracture is closed
- B Delaying surgery until the blisters have epithelialised, typically 7 to 14 days ✓
- C Unroofing all blisters and operating the same day
- D Lifelong avoidance of surgery because blistering predicts poor healing
Correct answer: B. Delaying surgery until the blisters have epithelialised, typically 7 to 14 days
Explanation
Fracture blisters represent dermal separation with compromised epidermis, and incising through them markedly raises wound breakdown and infection rates. Intact serous blisters are not an absolute contraindication, but definitive fixation is deferred until re-epithelialisation occurs, usually within 1 to 2 weeks, while maintaining reduction by closed means. Haemorrhagic blisters take longer and carry higher wound risk. Unroofing converts a sterile barrier into an open wound and does not permit same-day surgery.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.