Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures

This retrospective study investigated outcomes of wound healing in a series of 63 consecutive patients with 64 fractures of the calcaneus who underwen t open reduction and internal fixation done by two surgeons experienced in this fracture during a 3-year period. Thirty-nine patients were managed pre operatively as outpatient referrals before surgery. Twenty-four patients we re admitted directly to the trauma service and were managed as inpatients p reoperatively. Minimum patient follow-up was 6 months, with an average foll ow-up of 18 months. A trend correlating the time between injury and operati ve intervention with the incidence of complications in wounds was noted; th e incidence rose in patients who underwent surgery >5 days after their inju ry. Two-layered closures had a lower incidence of dehiscence compared to si ngle-layered tension-relieving sutures. Patients with a higher body-mass in dex (BMI) (kg/m(2)) took longer to heal their wounds. Strong trends were no ted to link BMI and severity of fractures. In the outpatient group, a histo ry of active smoking preoperatively correlated with increased time to wound healing. In 43 patients, there were no wound-healing complications. In 21 feet, there were varying degrees of wound dehiscence. Average wound healing took 47 days. Risk factors for complications in the wound after calcaneal open reduction and internal fixation include single layered closure, high B MI, extended time between injury and surgery, and smoking. Age, type of imm obilization, medical illness (including diabetes), type of bone graft, or u se of a Hemovac did not influence wound healing.