THE MANAGEMENT OF WOUND COMPLICATIONS FOLLOWING CALCANEAL FRACTURE FIXATION USING AN EXTENDED LATERAL APPROACH

Abstract

Background Open reduction and internal fixation for displaced intra-articular fractures of the calcaneum has become an established method of treatment. A recent randomised, controlled trial has questioned the benefits of surgery, in particular, pain relief.

Method We reviewed the cases undertaken in our department, complications which have arisen, and their treatment. We have devised a management plan in conjunction with the department of plastic surgery to minimise the effect of these complications. There were 124 procedures carried out over a 12-year period, 116 unilateral and 4 bilateral in 120 patients (106 males and 14 females, age range 18–66). Two further patients were included who had had surgery in another hospital and had been referred to our plastic surgery unit with significant wound complications.

The patients were retrospectively assessed with a case note review and an updated clinical evaluation. The assessment focussed particularly on wound complications including breakdown classified as either major or minor, and association with infection, haematoma and drainage. Neurological symptoms were also noted.

Results There were five major wound complications, three from our unit and two from another hospital. Infection was present in three cases. Four healed uneventfully but one of the infected group subsequently had a below knee amputation for refractory infection. Minor wound breakdown was more common. There was no association with haematoma or drainage but wound breakdown occurred more frequently in patients who smoked. Neurological complications were infrequent and temporary.

Conclusion This study confirmed that there is a significant morbidity associated with the surgical management of these fractures, although the vast majority of patients’ wounds healed uneventfully. With a sensible management plan, which involves working in conjunction with plastic surgeons, even major soft tissue complications may be addressed.