Regression analysis of controllable factors of surgical incision complications in closed calcaneal fractures

Background: In surgeries of closed calcaneal fractures, the lateral L-shaped incision is usually adopted. Undesirable post-operative healing of the incision is a common complication. In this retrospective study, controllable risk factors of incision complications after closed calcaneal fracture surgery through a lateral L-shaped incision are discussed and the eff ectiveness of clinical intervention is assessed. Materials and Methods: A review of medical records was conducted of 209 patients (239 calcaneal fractures) surgically treated from June 2005 to October 2012. Univariate analyses were performed of seven controllable factors that might infl uence complications associated with the surgical incision. Binomial multiple logistic regression analysis was performed to determine factors of statistical signifi cance. Results: Twenty-one fractures (8.79%) involved surgical incision complications, including 8 (3.35%) cases of wound dehiscence, 7 (2.93%) of fl ap margin necrosis, 5 (2.09%) of hematoma, and 1 (0.42%) of osteomyelitis. Five factors were statistically signifi cant: Th e time from injury to surgery, operative duration, post-operative drainage, retraction of skin fl ap, bone grafting, and patients’ smoking habits. Th e results of multivariate analyses showed that surgeries performed within 7 days after fracture, operative time > 1.5 h, no drainage after surgery, static skin distraction, and patient smoking were risk factors for calcaneal incision complications. Th e post-operative duration of antibiotics and bone grafting made no signifi cant diff erence. Conclusion: Complications after calcaneal surgeries may be reduced by postponing the surgery at least 7 days after fracture, shortening the time in surgery, implementing post-operative drainage, retracting skin fl aps gently and for as short a time as possible, and prohibiting smoking.