NON-OPERATION RELATED RISK FACTORS OF WOUND COMPLICATIONS OF CALCANEAL FRACTURES USING LATERAL EXTENSIVE L-SHAPED INCISION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAO Dongsheng ¹ , CHEN Chen ¹ , WANG Dong ² , YIN Yunsheng ²

1Department of Orthopedics, Shanxi Academy of Medical Sciences, Shanxi Grand Hospital, Taiyuan Shanxi, 030009, P.R.China;;
2Department of Orthopedics, the Second Hospital of Shanxi Medical University. Corresponding author: YIN Yunsheng, E-mail: yunshengyin@hotmail.com;

Corresponding author：

Keywords：

Calcaneal fracture; Wound complication; Risk factor

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Objective To analyze the non-operation related risk factors of the wound complications by using lateral extensive L-shaped incision for open reduction and internal fixation of calcaneal fractures. Methods A retrospective analysis was made on the clinical data of 58 patients with closed calcaneal fractures (63 calcaneus) treated by using lateral intensive L-shaped incision for open reduction and internal fixation between September 2006 and August 2011. There were 52 males (56 calcaneus) and 6 females (7 calcaneus), aged 18 to 64 years (mean, 35 years). The causes of injury included fall injury in 53 cases (58 calcaneus), traffic injury in 5 cases (5 calcaneus). The mean time between injury and operation was 8 days (range, 3-22 days). According to Sanders classification, 4 calcaneus were rated as type II, 31 calcaneus as type III, and 28 calcaneus as type IV. Postoperative complications were observed and graded; 58 patients were divided into complication group (≥grade 2) and control group ( lt; grade 2). The univariate analysis was used to analyze 18 factors which may lead to wound complications; multi-factor unconditioned logistic regression analysis was done for the factors showing significant difference. Results According to postoperative wound complications grading, 41 patients (46 calcaneus) were included in the control group, whose incision healed primarily, and 17 patients (17 calcaneus) in the complication group. In 17 patients of the complication group, 14 had skin necrosis or dehiscence, and 3 had superficial infection; they obtained healing after symptomatic treatment. The univariate analysis showed significant differences in combined spinal fracture, diabetes mellitus, and long-term smoking between 2 groups (P lt; 0.05). The logistic regression analysis revealed that combined spinal fracture was an independent risk factor for wound complications (95% confidence interval: 0.004-0.360, P=0.004). Conclusion Combined spinal fracture is an independent risk factor for wound complications after open reduction and internal fixation of calcaneal fracture using lateral extensive L-shaped incision.

Citation： HAO Dongsheng,CHEN Chen,WANG Dong,YIN Yunsheng. NON-OPERATION RELATED RISK FACTORS OF WOUND COMPLICATIONS OF CALCANEAL FRACTURES USING LATERAL EXTENSIVE L-SHAPED INCISION. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(1): 30-35. doi: Copy

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2.	Harvey EJ, Grujic L, Early JS, et al. Morbidity associated with ORlF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int, 2001, 22(11): 868-873.
3.	Koski A, Kuokkanen H, Tukiainen E. Postoperative wound complications after internal fixation of closed calcaneal fractures: a retrospective analysis of 126 consecutive patients with 148 fractures. Scand J Surg, 2005, 94(3): 243-245.
4.	Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
5.	郝东升, 尹芸生, 李栋, 等. 螺旋CT三维重建在跟骨骨折手术治疗中的价值. 中国现代医学杂志, 2006, 16(23): 3611-3614.
6.	Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am), 2000, 82(2): 225-250.
7.	Lim EV, Leung JP. Complications of intraarticular calcaneal fractures. Clin Orthop Relat Res, 2001, (391): 7-16.
8.	Makki D, Alnajjar HM, Walkay S, et al. Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. J Bone Joint Surg (Br), 2010, 92(5): 693-700.
9.	Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma, 1999, 13(5): 369-372.
10.	Jorgensen LN, Kallehave F, Christensen E, et al. Less collagen production in smokers. Surgery, 1998, 123(4): 450-455.
11.	Thomsen T, Tønnesen H, Møller AM. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. Br J Surg, 2009, 96(5): 451-461.
12.	Møller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet, 2002, 359(9301): 114-117.
13.	Court-Brown CM, Schmied M, Schutte BG. Factors affecting infection after calcaneal fracture fixation. Injury, 2009, 40(12): 1313-1315.
14.	Wukich DK, Lowery NJ, McMillen RL, et al. Postoperative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus. J Bone Joint Surg (Am), 2010, 92(2): 287-295.
15.	Currie CJ, Peters JR, Tynan A, et al. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet, 2010, 375(9713): 481-489.
16.	Sabanayagam C, Liew G, Tai ES, et al. Relationship between glycated haemoglobin and microvascular complications: is there a natural cut-off point for the diagnosis of diabetes? Diabetologia, 2009, 52(7): 1279-1289.
17.	龚振华, 姚建, 季建峰, 等. 负压封闭引流技术治疗软组织损伤合并感染创面. 中华创伤杂志, 2012, 28(1): 76-77.
18.	李楠, 万春友, 崔猛, 等. 改良封闭式负压引流技术在骨科创面治疗中的应用. 中国修复重建外科杂志, 2012, 26(1): 125-126.
19.	Stannard JP, Volgas DA, McGwin G 3rd, et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma, 2012, 26(1): 37-42.
20.	刘新成, 陈雁西, 俞光荣. 手术治疗跟骨骨折并发症的Meta分析. 中华创伤杂志, 2010, 26(2): 109-113.

1. Howard JL, Buckley R, McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma, 2003, 17(4): 241-249.
2. Harvey EJ, Grujic L, Early JS, et al. Morbidity associated with ORlF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int, 2001, 22(11): 868-873.
3. Koski A, Kuokkanen H, Tukiainen E. Postoperative wound complications after internal fixation of closed calcaneal fractures: a retrospective analysis of 126 consecutive patients with 148 fractures. Scand J Surg, 2005, 94(3): 243-245.
4. Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
5. 郝东升, 尹芸生, 李栋, 等. 螺旋CT三维重建在跟骨骨折手术治疗中的价值. 中国现代医学杂志, 2006, 16(23): 3611-3614.
6. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am), 2000, 82(2): 225-250.
7. Lim EV, Leung JP. Complications of intraarticular calcaneal fractures. Clin Orthop Relat Res, 2001, (391): 7-16.
8. Makki D, Alnajjar HM, Walkay S, et al. Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. J Bone Joint Surg (Br), 2010, 92(5): 693-700.
9. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma, 1999, 13(5): 369-372.
10. Jorgensen LN, Kallehave F, Christensen E, et al. Less collagen production in smokers. Surgery, 1998, 123(4): 450-455.
11. Thomsen T, Tønnesen H, Møller AM. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. Br J Surg, 2009, 96(5): 451-461.
12. Møller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet, 2002, 359(9301): 114-117.
13. Court-Brown CM, Schmied M, Schutte BG. Factors affecting infection after calcaneal fracture fixation. Injury, 2009, 40(12): 1313-1315.
14. Wukich DK, Lowery NJ, McMillen RL, et al. Postoperative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus. J Bone Joint Surg (Am), 2010, 92(2): 287-295.
15. Currie CJ, Peters JR, Tynan A, et al. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet, 2010, 375(9713): 481-489.
16. Sabanayagam C, Liew G, Tai ES, et al. Relationship between glycated haemoglobin and microvascular complications: is there a natural cut-off point for the diagnosis of diabetes? Diabetologia, 2009, 52(7): 1279-1289.
17. 龚振华, 姚建, 季建峰, 等. 负压封闭引流技术治疗软组织损伤合并感染创面. 中华创伤杂志, 2012, 28(1): 76-77.
18. 李楠, 万春友, 崔猛, 等. 改良封闭式负压引流技术在骨科创面治疗中的应用. 中国修复重建外科杂志, 2012, 26(1): 125-126.
19. Stannard JP, Volgas DA, McGwin G 3rd, et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma, 2012, 26(1): 37-42.
20. 刘新成, 陈雁西, 俞光荣. 手术治疗跟骨骨折并发症的Meta分析. 中华创伤杂志, 2010, 26(2): 109-113.

Chinese Journal of Reparative and Reconstructive Surgery

NON-OPERATION RELATED RISK FACTORS OF WOUND COMPLICATIONS OF CALCANEAL FRACTURES USING LATERAL EXTENSIVE L-SHAPED INCISION

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