A 10-year report of post-operative complications of calcaneal fractures treated by internal fixation: who is at risk?

O. Salar, F. Shivji, J. Holley, B. Choudhry, A. Taylor, C.G. Moran

Introduction: We report our 10-year experience of post-operative complications of calcaneal fractures treated by internal fixation and attempt to correlate these with previously cited patient risk factors.

Methods: All calcaneal fractures treated by internal fixation in our Major Trauma Centre between September 2002 and September 2012 were identified. Patient indices (age, gender, smoking status and pre-existing comorbidities), time to surgery and method of surgery (open reduction and internal fixation (ORIF) versus closed reduction and percutaneous fixation) were recorded. Primary outcome was the incidence of wound infection requiring intravenous antibiotics and/or re-operation. Statistical analysis through Mann-Whitney-Wilcoxon testing and relative risk ratio calculations with 95% Confidence Intervals (CI) was performed.

Results: 98 calcaneal fractures in 92 patients were identified. 79 (80.6%) fractures occurred in males, 19 (19.4%) in females. 54 (55.1%) were smokers and 44 (44.9%) non-smokers. 18 (18.4%) were treated by closed reduction and percutaenous fixation and 80 (81.6%) by ORIF. 3 (3.1%) patients (all male) developed post-operative wound infection (RR 0.96, 95% CI 0.92-1.00), of which 1 was a smoker (RR 1.03 95% CI 0.95-1.11). All infections occurred in patients treated percutaneously (RR 6.33, 95% CI 3.99- 10.08). There was no significant difference in mean time to surgery (p=0.069) and mean age (p=0.31) for those patients experiencing wound complications and those who did not.

Conclusions: This study reports an overall wound infection rate in keeping with current literature. There was no statistically significant increased risk of wound infection in smokers or male patients. All infections occurred in patients who had percutaneous treatment. These findings support the continued treatment of displaced calcaneal fractures by open reduction and internal fixation through a conventional extended lateral approach. There is no justification in denying surgery to males or smokers although these two factors have been cited as poor prognostic indicators in earlier studies.