Session IV - Foot & Ankle

Fri., 10/6/06 Foot & Ankle, Paper #21, 10:27 am

Timing of Surgery and Wound Complications in Calcaneus Fractures

Telly Psaradellis, MD (n); Timothy Weber, MD (n);
Brent Wiersema, DO (n); Corey VandeZandschulp, MD (n);
Marcus B. Stone, PhD (n);
OrthoIndy, Indianapolis, Indiana, USA

Purpose: Operative treatment of calcaneus fractures is associated with a risk of early wound complications. Although accepted practice dictates that surgery should be delayed until soft tissues recover from the initial traumatic insult, optimal timing of surgery has not been delineated. A single surgeon at our institution has developed an aggressive soft-tissue management protocol designed to decrease the time delay from injury to surgery. The purpose of this study was to determine if this earlier operative treatment affects complication rate or quality of reduction.

Methods: 96 patients (16 female, 80 male, mean age = 39.7 ± 14.0 years, mean follow up = 9.9 ± 12.0 months) with 101 calcaneus fractures treated by a single surgeon between 1995 and 2005 were identified from a pre-existing database. Mechanism of injury included 69 falls from height, 24 motor vehicle accidents, 7 low-energy accidents, and 1 motorcycle accident. Patients who underwent definitive fixation within 5 days of injury comprised the early surgical group; all others were placed into the delayed group. Quality of reduction was determined by measuring Bohler's angle and posterior facet articular step-off on all available (73) postoperative lateral and Broden's view radiographs, respectively. Differences in complication rates and quality of reduction between the early and delayed treatment groups were analyzed using Yates-corrected chi squared analysis and Student't test, respectively.

Results: There were no differences in rate of complication (P = 0.511), Bohler's angle (P = 0.20) or posterior facet step-off (P = 0.36) between early and delayed surgical groups. Complications encountered include (early/delayed): 3/3 epidermolysis, 0/7 drainage, 1/4 hematoma, 1/1 deep infection, and 0/1 osteomyelitis. The early group required no secondary operations while the delayed group required four. Mean time from injury to surgery was 3.7 ± 1.3 days for the early group and 10.5 ± 4.7 days for the delayed group.

Conclusion/Significance: Earlier operative intervention in calcaneus fractures has a number of potential benefits, such as facilitating accurate reduction, avoiding soft-tissue contracture, and initiating early joint motion. The results of this study suggest that under the proper circumstances, surgical management of these fractures within the first 5 days of injury is a feasible treatment option.

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· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.