Risk Factors for Infection and Amputation Following Open, Combat-Related Calcaneal Fractures

Abstract

Lower-extremity amputation following open calcaneal fractures is predicted by the injury mechanism, wound location and size, and open fracture type and severity. After short-term follow-up, patients with open calcaneal fractures eventually requiring amputation exhibit improved pain and activity levels compared with patients with continued, ostensibly successful limb salvage.

Contemporary demographics and complications of patients treated for open ankle fractures

“…Interestingly, advanced age was not associated with either of these complications. Previous studies with combat-related injuries to the hindfoot and ankle have shown amputation rates as high as 45% [15,16,22]. In contrast to these previous findings, in our study a lower-leg amputation was required in only three patients (2%), reflecting the different nature of this open injury compared to other open injuries of the lower extremity.…”

“…In contrast, younger patients with an open ankle fracture often needed more reconstructive procedures for softtissue coverage and had significantly more complications including chronic pain, probably due to the more severe injury mechanism and initial soft-tissue damage. This finding is in line with previous studies showing that higher Gustilo grade correlates well with the risk of infection and other associated complications of open fractures [4,7,10,16,17].…”

Determination of Pathogens in Postoperative Wound Infection After Surgically Reduced Calcaneal Fractures and Implications for Prophylaxis and Treatment

“…To the best of our knowledge, no studies have yet determined the causative pathogens of POWI after operative treatment of calcaneal fractures, although some studies have specified the pathogens for calcaneal osteomyelitis. Overall, these studies reported S. aureus as the main pathogen (19)(20)(21). In a study of infection after all types of orthopedic open fractures, the most frequently identified microorganisms were Enterobacter species and Pseudomonas (31%), followed by Enterococcus species in 27% of cases (22).…”

Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

“…Soft tissue and osseous infections accounted for over 25% and 35% of all complications in the pre-amputation and postamputation time periods, respectively. The high rate of infection is comparable to similar studies evaluating similar patient cohorts and may give pause to surgeons and limb salvage patients who desire an amputation as a means to eradicate infection [7,18,21,[27][28][29][30]. In fact, Melcer et al showed that late amputees actually had higher rates of infectious complications and nonhealing wounds compared to limb salvage patients and acute amputees [18].…”