SLR - February 2023 - Throy Austero, DPM
Title: Risk factor of postoperative incision infection after plate internal fixation of calcaneal fractures: a retrospective studyReference: Shen L, Wang Q, Chen J, Jiang Z. Risk factor of postoperative incision infection after plate internal fixation of calcaneal fractures: a retrospective study. BMC Musculoskelet Disord. 2022 Dec 14;23(1):1091.
Level of Evidence: Level IV
Reviewed By: Throy Austero, DPM
Residency Program: CarePoint Health – Hoboken University Medical Center (Hoboken, NJ)
Podiatric Relevance: Calcaneal fractures account for approximately 1-4% of all fractures in adults. Open reduction and internal fixation of calcaneal fractures is typically performed in patients with loss of height of the subtalar joint, comminution, and intra-articular violation. A common complication associated with open reduction and internal fixation of calcaneal fractures is incision infection. Although there are several different and modified incision types to address the fracture, the most traditional and common incision is the L-shaped approach. The purpose of this study was to determine the risk factors for incision infection in patients with calcaneal fractures treated by plate internal fixation via traditional lateral L-shaped incision.
Methods: A retrospective analysis was performed for patients who received plate internal fixation for their calcaneal fractures via traditional lateral L-shaped incision at the authors hospital from January 2012 to June 2018. A total of 177 males and 125 females were included in the study. The main outcome measures of this study were conducted through a univariate analysis including sex, age, smoking history, history of diabetes, cause of injury, Sanders type, tension blisters, time from injury to surgery, preoperative hemoglobin, preoperative albumin, operation time, and bone grafting as possible risk factors.
Results: The patients were divided into an infection group (n=24; 7.9%) and a non-infection group (n=278; 92.1%) and were followed up for at least 1 year, with a mean follow-up time of 15.8 months. The study showed significant differences concerning the incidence of preoperative tension blisters, smoking history, history of diabetes, preoperative hemoglobin, preoperative albumin, time from injury to surgery, and operation time between the two groups. Their findings further showed that a shorter time from injury to surgery, longer operation time, and a lower preoperative albumin were risk factors for postoperative infection. The clinical threshold value of time from injury to surgery, operation time, and preoperative albumin were 10.5 days, 84.5 minutes, and 38.5 g/L, respectively.
Conclusions: This study found an overall postoperative infection rate of 7.9% (24/302) in patients treated with plate internal fixation for their calcaneal fractures via traditional lateral L-shaped approach. The limitations of this study included, but are not limited to, low level of evidence, other potential risk factors, and variations in the trauma and treatment of different Sanders types. In summary, the risk factors for postoperative incision infection were longer preoperative stay and operation time as well as lower preoperative albumin levels, which was the highest risk factor in their study.