Risk factors for surgical site infections with the Sinus Tarsi Approach in displaced intra-articular calcaneal fractures; a prospective cohort study with a minimum of one year follow-up

Abstract

Background: In the last decade, the sinus tarsi approach (STA) has gained interest over the extensile lateral approach (ELA) in the operative treatment of displaced intra-articular calcaneal fractures (DIACF's), mainly because of the lower rate of surgical site infections (SSIs). However, most studies are small and retrospective. The aim of this study was to evaluate the rate of SSIs of the STA in a large, prospective series of patients and to identify predictors for SSIs. Methods: In this prospective cohort study, all consecutive patients who were operatively treated for a DIACF in our Level 1 trauma center between August 2012 and January 2019 were included and followed for at least one year. All operative procedures were performed by two specialized foot and ankle trauma surgeons using the STA. Using multinomial logistic regression, risk factors for SSIs were identified. Results: A total of 237 calcaneal fractures in 214 patients were included, of which 179 underwent open reduction and internal fixation and 58 a primary arthrodesis. Most patients were male (73.6%) and the mean age was 45.9 years. There were 16 patients that developed a SSI (6.8%), of which 9 (3.8%) were deep and 7 (3%) were superficial infections. The multivariate analysis pointed out that surgery within one week after injury increased the chance of a SSI, as well as an ASA of 2 or higher and more than 150 cc of blood loss during the procedure. Conclusion: This study confirms the low risk of SSI in DIACFs treated via STA. Significant predictors for SSIs were surgery within one week after injury, ASA of 2 or higher and blood loss > 150cc.

Risk prediction model for deep surgical site infection (DSSI) following open reduction and internal fixation of displaced intra‐articular calcaneal fracture

“…In the present study, we used a thoroughly selected population with a huge amount of sample to address the risk factors of DSSI following calcaneal fracture. It is of note, four out of five factors identified had been repeatedly investigated and their role was well‐established across studies with different levels of evidence 4,8‐10,19 . The only difference among them might be the determination of cut‐off values of BMI, for which we used both the traditional value (28.0 g/m 2 , for definition of obesity for Chinese people) and the current value of 26.4 kg/m 2 to make a dichotomization.…”

“…For some variables (smoking) volume and frequency might be particularly important parameters in infection complications, but detailed data were not available. Second, the volume of surgeon might affect the results, because surgical treatment of calcaneal fracture needs a learning curve, especially for tarsal sinus 19 . As plenty of surgeons perform operations, the sample size of operations for each surgeon in 1 year is too small to obtain effective statistical analyses.…”

Response to “Letter Regarding: Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy”

“…However, a recent study reported that early ORIF within 1 week carries a risk of surgical site infection. 4 We believe that the staged approach as a concept of damage control surgery can be a safe and effective strategic option for complicated fractures, such as polytrauma and open fractures. 3 We agree that our protocol may increase some costs.…”

Application of medial column classification in treatment of intra-articular calcaneal fractures

“…However, the surgical operation causes great damage to soft tissue. Therefore, there has been much controversy about postoperative complications, such as wound infection and nonhealing[ 2 ]. With the in-depth development of minimally invasive treatment of calcaneal fractures, many doctors use the tarsal sinus approach to fix calcaneal fractures.…”