Early Wound Complications of Operative Treatment of Calcaneus Fractures: Analysis of 190 Fractures

OBJECTIVES:The purpose of the present study was to discover any associations between preoperative variables and the occurrence of wound complications in the surgical treatment of calcaneus fractures. DESIGN:Retrospective review. SETTING:A Level 1 trauma center. PATIENTS:One hundred seventy-nine patients, with 190 fractured calcanei, were studied. INTERVENTION:Each patient underwent open reduction and internal fixation for calcaneus fractures with standard techniques. MAIN OUTCOME MEASUREMENTS:The age, sex, preexisting medical conditions, social history, and mechanism of injury of each patient were recorded. Note was made of the status of the soft tissue injury, if any. The time from injury to surgical stabilization was recorded, as was the type of incision used, use of preoperative antibiotics, and type of wound closure. The patients' records were reviewed for wound complications. These complications were classified as those that could be treated nonsurgically and those that required surgical management. RESULTS:Records from July 1992 to July 1998 showed 179 patients who underwent operative stabilization of a calcaneus fracture. Eleven had bilateral fractures, for a total of 190 fractured calcanei. The average age was thirty-five years. Nine patients were diabetics. One hundred eleven of the patients reported current use of cigarettes. Eighteen of the fractures were open. A standard, L-shaped lateral approach to the calcaneus was used in each case. Stabilization was achieved by using standard techniques, with plates and screws. In all cases, a two-layer wound closure was used. Forty-eight patients (25 percent) developed some form of wound complication. Forty (21 percent) of these required surgical treatment. Statistical analysis identified diabetes (p = 0.02; relative risk 3.4), smoking (p = 0.03; relative risk 1.2), and open fractures (p < 0.0001; relative risk 2.8) as risk factors for wound complication. The presence of more than one risk factor increased the relative risk of a wound complication requiring surgery. CONCLUSION:Smoking, diabetes, and open fractures all increase the risk of wound complication after surgical stabilization of calcaneus fractures. Cumulative risk factors increase the likelihood of wound complications. Patients who have the risk factors identified in this study should be counseled as to the possible complications that may arise after surgery. In patients with multiple risk factors, consideration should be given to nonsurgical m