title: Risk factors for postoperative wound complications of calcaneal fractures following plate fixation.
abstract: BACKGROUND
  A fairly high prevalence of wound complications after open reduction and internal plate fixation (ORIF) of closed calcaneal fractures via the extensile lateral approach has been reported. The goal of this study was to analyze and identify independent risk factors for wound complications among closed calcaneal fractures undergoing ORIF.
  
  
  METHODS
  The medical records of all closed calcaneal fracture patients who underwent ORIF from July 2005 to July 2012 were reviewed to identify those who developed a wound complication. Then we constructed a univariate and multivariate logistic regression to evaluate the independent associations of potential risk factors for surgical wound complication. Records showed 479 patients who underwent ORIF of a closed calcaneal fracture from July 2005 to July 2012. The patients were followed for 3 to 28 months, with an average follow-up period of 14.2 months. Eleven patients had bilateral fractures, for a total of 490 fractured calcanei.
  
  
  RESULTS
  The overall rate of postoperative wound complications following ORIF of closed calcaneus fractures was 17.8% (87 wound complications in 490 operations). With the regression model, smoking history (odds ratio, 5.79; 95% CI: 1.55 to 21.70; P = .009), diabetes mellitus (odds ratio, 6.23; 95% CI: 1.37 to 28.31; P = .018), Sanders type (odds ratio, 5.44; 95% CI: 2.02 to 14.64; P = .001), number of residents and/or fellows present during the case (odds ratio, 1.63; 95% CI: 1.06 to 2.52; P = .028), duration of surgery (odds ratio, 4.54; 95% CI: 1.46 to 14.12; P < .001), estimated blood loss (odds ratio, 1.02; 95% CI: 1.01 to 1.04%; P < .001), and 10 or more people present in the operating room during the entire case (odds ratio, 2.30; 95% CI: 1.79 to 2.94; P < .001) were risk factors for wound complication. Tourniquet use (odds ratio, 0.02; 95% CI: 0.00 to 0.08; P < .001), which was associated with a decreased risk for the development of a wound complication, was observed as a protective factor. Diabetes mellitus, Sanders type, and smoking were the strongest risk factors for postoperative wound complication after adjusting for all other variables.
  
  
  CONCLUSIONS
  Smoking, diabetes mellitus, Sanders type, number of residents and/or fellows present during the case, duration of surgery, estimated blood loss, and high number of persons present in the operating room during the entire case were related to an increased risk for postoperative wound complication of closed calcaneal fractures following ORIF. Tourniquet use was associated with a decreased risk for the development of a wound complication.
  
  
  METHODS
  Level III, retrospective comparative series.
authors.affiliation: Shanghai Fengxian Central Hospital, Shanghai, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Ding
authors.forename: Zhimin
authors.initials: Z
authors.lastname: He
authors.forename: Haijun
authors.initials: H
authors.lastname: Xiao
authors.forename: Leizi
authors.initials: L
authors.lastname: Chai
authors.forename: Feng
authors.initials: F
authors.lastname: Xue
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001860:Bone Plates; D002111:Calcaneus / Q000293:injuries*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
keywords: ORIF; calcaneus; fracture; internal fixation; open reduction; wound complication