Wound-Healing Risk Factors After Open Reduction and Internal Fixation of Calcaneal Fractures

Abstract

This retrospective study investigated outcomes of wound healing in a series of 63 consecutive patients with 64 fractures of the calcaneus who underwent open reduction and internal fixation done by two surgeons experienced in this fracture during a 3-year period. Thirty-nine patients were managed preoperatively as outpatient referrals before surgery. Twenty-four patients were admitted directly to the trauma service and were managed as inpatients preoperatively. Minimum patient follow-up was 6 months, with an average follow-up of 18 months. A trend correlating the time between injury and operative intervention with the incidence of complications in wounds was noted; the incidence rose in patients who underwent surgery >5 days after their injury. Two-layered closures had a lower incidence of dehiscence compared to single-layered tension-relieving sutures. Patients with a higher body-mass index (BMI) (kg/ m2) took longer to heal their wounds. Strong trends were noted to link BMI and severity of fractures. In the outpatient group, a history of active smoking preoperatively correlated with increased time to wound healing. In 43 patients, there were no wound-healing complications. In 21 feet, there were varying degrees of wound dehiscence. Average wound healing took 47 days. Risk factors for complications in the wound after calcaneal open reduction and internal fixation include single layered closure, high BMI, extended time between injury and surgery, and smoking. Age, type of immobilization, medical illness (including diabetes), type of bone graft, or use of a Hemovac did not influence wound healing.

Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach

“…Unfortunately no specific data on calcaneal fracture surgery were available in this study. Closed suction drain placement has previously not been shown to reduce wound healing complications [20]. However, in our study placement of a closed suction drain during surgery resulted in a significant decrease of post-operative wound infections.…”

“…Factors that were associated with an increased risk for wound infections were ASA classification other than 1 and absence of a closed suction drain placement at the end of surgery. None of the previously reported risk factors (higher BMI, drug abuse, smoking, outpatient management and surgery after more than five or 14 days) showed a relation with a post-operative wound infection in our study [5,12,20,21] (Table 3). As there was no difference in wound infections between pre-operative in-or outpatients we find that pre-operative outpatient management is acceptable.…”

“…In addition, the incidence of wound infections increased in patients who were managed as outpatients pre-operatively or underwent surgery more than five or 14 days following trauma [5,20,21]. However, another recent retrospective study showed no correlation with surgical timing [22].…”

“…However, another recent retrospective study showed no correlation with surgical timing [22]. Intra-operative risk factors were surgical experience [12,23] and a single layered closure technique [20].…”

“…Some studies identified covariates associated with an increased risk of wound complications such as a higher body mass index (BMI), smoking [5,20] and drug abuse [12]. In addition, the incidence of wound infections increased in patients who were managed as outpatients pre-operatively or underwent surgery more than five or 14 days following trauma [5,20,21].…”