title: Indications for implant removal following intra-articular calcaneal fractures and subsequent complications.
abstract: BACKGROUND
  Implant removal following operative calcaneal fracture treatment has received little attention in the literature. The aim of the current retrospective cohort study was to assess the indications and number of wound complications following calcaneal plate removal.
  
  
  METHODS
  All consecutive adult patients who had their plate and screws removed following the operative treatment of a closed uni- or bilateral intra-articular calcaneal fracture using a stainless steel nonlocking calcaneal plate between 2000 and 2011 were included.
  
  
  RESULTS
  In 102 patients (46% of the total number of operated calcaneal fractures) implants were removed. Implant removal was performed in 75 patients for symptomatic reasons, in 10 patients due to implant malposition and in 19 patients because of a persistent wound infection or fistula. Following implant removal 17 (16%) patients had a wound complication (2 wound dehiscence, 15 culture positive wound infections). In 6 patients (9%) a wound complications was seen following implant removal after uncomplicated fracture surgery. Implant removal for active infection or plate fistula displayed an infection rate of 8 out of 19 (42%).
  
  
  CONCLUSIONS
  Implant removal after an intra-articular calcaneal fracture treated with open reduction and internal fixation via an extended lateral approach was followed by a wound complication in 1 of every 10 patients without a preexisting wound infection. Infection rates were especially high in patients in whom the implants were removed for an active wound problem.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Manouk
authors.initials: M
authors.lastname: Backes
authors.forename: Niels W L
authors.initials: NW
authors.lastname: Schep
authors.forename: Jan S K
authors.initials: JS
authors.lastname: Luitse
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.forename: Tim
authors.initials: T
authors.lastname: Schepers
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D002111:Calcaneus / Q000293:injuries / Q000601:surgery*; D015331:Cohort Studies; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery
keywords: antibiotic prophylaxis; calcaneal fracture; complications; implant removal; trauma