Folk, J Orthop Trauma 1999 - Early Wound Complications of Operative Treatment of Calcaneus Fractures: Analysis of 190 Fractures

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

Folk, Early, et al.·J Orthop Trauma·1999·401 citations·Retrospective cohort

Purpose

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.

Methods

Design: Retrospective review.

Setting: A Level 1 trauma center.

Patients: 179 patients, with 190 fractured calcanei, were studied.

Intervention: Each patient underwent open reduction and internal fixation for calcaneus fractures with standard techniques.

Main Outcome Measures:

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.
11 had bilateral fractures, for a total of 190 fractured calcanei.
The average age was 35 years.
9 patients were diabetics.
111 of the patients reported current use of cigarettes.
18 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 2-layer wound closure was used.
48 patients (25 percent) developed some form of wound complication.
40 (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.

Conclusions

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 management.

Copyright remains with the authors and publisher.

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

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Effects of Bracing in Adolescents with Idiopathic Scoliosis.

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Adolescent Idiopathic Scoliosis: A New Classification to Determine Extent of Spinal Arthrodesis.

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Problems in the Management of Type III (Severe) Open Fractures: A New Classification of Type III Open Fractures.

Gustilo, Williams, et al.J Trauma19842,361 citationsRetrospective cohort

Neer Award 2005: The Grammont Reverse Shoulder Prosthesis: Results in Cuff Tear Arthritis, Fracture Sequelae, and Revision Arthroplasty.

Boileau, Hovorka, et al.J Shoulder Elbow Surg20061,115 citationsProspective cohort

A System for the Surgical Staging of Musculoskeletal Sarcoma.

Enneking, Goodman, et al.Clin Orthop Relat Res19802,112 citationsRetrospective cohort

Fracture Fixation in the Operative Management of Hip Fractures (FAITH): An International, Multicentre, Randomised Controlled Trial.

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Goutallier, Voisin, et al.Clin Orthop Relat Res19942,669 citationsProspective cohort

Dislocations after Total Hip-Replacement Arthroplasties.

Lewinnek, Zimmerman, et al.J Bone Joint Surg Am19782,549 citationsRetrospective cohort

Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis.

Walch, Khoury, et al.J Arthroplasty19991,142 citationsRetrospective cohort

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DenisSpine (Phila Pa 1976)19832,566 citationsRetrospective cohort

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A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.

Vaccaro, Oner, et al.Spine (Phila Pa 1976)2005866 citationsConsensus statement

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FLOW Investigators, Guyatt, et al.N Engl J Med2015347 citationsRCT

Curve Progression in Idiopathic Scoliosis.

Weinstein, PonsetiJ Bone Joint Surg Am1983641 citationsRetrospective cohort

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Burkhart, De BeerArthroscopy20001,884 citationsCase series

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Baumgaertner, Keggi, et al.J Bone Joint Surg Am19951,441 citationsRetrospective cohort

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Berndt, HartyJ Bone Joint Surg Am1959945 citationsBiomechanical study

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Weinstein, SPORT Investigators, et al.N Engl J Med20081,207 citationsRCT

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Burkhart, Jolson, et al.Arthroscopy1993469 citationsAnatomic study

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O'Driscoll, Morrey, et al.J Bone Joint Surg Am1991997 citationsCase series

Preoperative versus Postoperative Radiotherapy in Soft-Tissue Sarcoma of the Limbs: A Randomised Trial.

O'Sullivan, Zee, et al.Lancet20021,587 citationsRCT

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Microvasculature of the Human Meniscus.

Arnoczky, WarrenAm J Sports Med19821,227 citationsAnatomic study

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MirelsClin Orthop Relat Res19891,222 citationsRetrospective cohort

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Fehlings, Rampersaud, et al.PLoS One20121,200 citationsProspective cohort

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Patchell, Young, et al.Lancet20052,356 citationsRCT

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Salter, HarrisJ Bone Joint Surg Am19631,737 citationsRetrospective cohort

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Neer, Fukuda, et al.J Bone Joint Surg Am1983774 citationsCase series

A System of Staging Musculoskeletal Neoplasms.

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O'DriscollActa Orthop Belg199959 citationsReview article

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Sanders, Walling, et al.Clin Orthop Relat Res1993891 citationsProspective cohort

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Jobe, Lombardo, et al.J Bone Joint Surg Am1986758 citationsCase series

Replacement Arthroplasty for Glenohumeral Osteoarthritis.

NeerJ Bone Joint Surg Am1974598 citationsCase series

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HawkinsJ Bone Joint Surg Am1970556 citationsRetrospective cohort

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Stiell, Worthington, et al.JAMA20011,283 citationsProspective cohort

The Arterial Vascularization of the Humeral Head. An Anatomical Study.

Gerber, Vinh, et al.J Bone Joint Surg Am1990441 citationsAnatomic study

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Snyder, Friedman, et al.Arthroscopy19901,264 citationsCase series

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NeerJ Bone Joint Surg Am1972536 citationsCase series

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Dejour, Guier, et al.Knee Surg Sports Traumatol Arthrosc19941,987 citationsCase-control study

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Judet, Letournel, et al.J Bone Joint Surg Am1964980 citationsCase series

Inferior Capsular Shift for Involuntary Inferior and Multidirectional Instability of the Shoulder. A Preliminary Report.

Neer, FosterJ Bone Joint Surg Am1980934 citationsCase series

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Glassman, Schwab, et al.Spine (Phila Pa 1976)20051,878 citationsRetrospective cohort

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Poppen, WalkerJ Bone Joint Surg Am1976886 citationsCase-control study

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Harms, MelcherSpine (Phila Pa 1976)20011,528 citationsCase series

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Hoffman, Zucker, et al.N Engl J Med20001,302 citationsProspective cohort

Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture

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SwansonJ Hand Surg Am1976429 citationsReview article

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PipkinJ Bone Joint Surg Am1957445 citationsCase series

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Anderson, Park, et al.J Bone Joint Surg Am1975416 citationsCase series

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Herring, Browne, et al.J Bone Joint Surg Am2004143 citationsProspective cohort

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KiblerAm J Sports Med19981,240 citationsReview article

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Watson, BalletJ Hand Surg Am19841,138 citationsRetrospective cohort

Classification and an Algorithmic Approach to the Reconstruction of Femoral Deficiency in Revision Total Hip Arthroplasty.

Valle, PaproskyJ Bone Joint Surg Am2003199 citationsRetrospective cohort

The Tibial Plateau Fracture. The Toronto Experience 1968--1975.

Schatzker, Bruce, et al.Clin Orthop Relat Res19791,029 citationsRetrospective cohort

Surgical Dislocation of the Adult Hip a Technique with Full Access to the Femoral Head and Acetabulum without the Risk of Avascular Necrosis.

Ganz, Berlemann, et al.J Bone Joint Surg Br20011,367 citationsCase series

Predictors of Humeral Head Ischemia after Intracapsular Fracture of the Proximal Humerus.

Hertel, Leunig, et al.J Shoulder Elbow Surg2004837 citationsProspective cohort

Early versus Delayed Stabilization of Femoral Fractures. A Prospective Randomized Study.

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Acetabulum Fractures: Classification and Management.

LetournelClin Orthop Relat Res1980715 citationsRetrospective cohort

A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group.

Fisher, Fourney, et al.Spine (Phila Pa 1976)20101,224 citationsConsensus statement

Surgical vs. Nonsurgical Treatment of Adults with Displaced Fractures of the Proximal Humerus: The PROFHER Randomized Clinical Trial.

Rangan, PROFHER Trial Collaborators, et al.JAMA2015540 citationsRCT

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WeberSpine (Phila Pa 1976)19831,149 citationsRCT

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

Folk, Early, et al.·J Orthop Trauma·1999·401 citations·Retrospective cohort

Purpose

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.

Methods

Design: Retrospective review.

Setting: A Level 1 trauma center.

Patients: 179 patients, with 190 fractured calcanei, were studied.

Intervention: Each patient underwent open reduction and internal fixation for calcaneus fractures with standard techniques.

Main Outcome Measures:

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.
11 had bilateral fractures, for a total of 190 fractured calcanei.
The average age was 35 years.
9 patients were diabetics.
111 of the patients reported current use of cigarettes.
18 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 2-layer wound closure was used.
48 patients (25 percent) developed some form of wound complication.
40 (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.

Conclusions

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 management.

Copyright remains with the authors and publisher.

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