Abstract
BackgroundTo better clinical outcomes, open reduction and internal fixations (ORIFs) have been commonly performed in the case of closed displaced intra-articular calcaneal fractures (CDICFs). Nonetheless, postoperative wound complications remain a significant problem. Therefore, the aim of our study is to summarise relevant evidence investigating the risk factors for postoperative wound complications of CDICFs following ORIFs.MethodsA meta-analysis was conducted on relevant clinical studies to identify the risk factors for wound complications of CDICFs after ORIFs. Electronic databases were searched for all relevant studies up to October 2014. The Newcastle-Ottawa scale was used to evaluate the methodological quality, and study-specific odds ratios (ORs) were pooled using the fixed-effects model or random-effects model. Sensitivity analysis and meta-regression analysis was performed to evaluate the heterogeneity.ResultsTen observational studies involving 1559 patients with 1651 fractures were included in this meta-analysis. The results showed that diabetes (OR, 9.76; p < 0.01), no drainage (OR, 5.86; p < 0.01), fracture severity (OR, 3.31; p < 0.01) and bone graft (OR, 1.74; p < 0.01) were the risk factors for wound complications of CDICFs after ORIFs. A trend of more wound complications in patients with a history of smoking was detected. However, female patients, ORIFs performed within 14 days of injury, smoking, hypertension and drinking did not significantly increase the risk of wound complications (p > 0.05).ConclusionsBased on available relevant evidence, bone graft, diabetes, no drainage and fracture severity were all associated with an increased risk of wound complications after ORIF for CDICFs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0092-4) contains supplementary material, which is available to authorized users.
Highlights
To better clinical outcomes, open reduction and internal fixations (ORIFs) have been commonly performed in the case of closed displaced intra-articular calcaneal fractures (CDICFs)
Inclusion criteria We identified studies according to the following inclusion criteria: (1) participants: human adults with CDICFs; (2) intervention: ORIF; (3) comparison: patients with potential risk factors versus patients without potential risk factors resulting in higher or lower rate of wound complications; (4) sufficient data were available for estimating an odds ratio (OR) with confidence interval (CI)
The most important finding of the meta-analysis was that bone graft, diabetes, no drainage and fracture severity were identified as risk factors for wound complications of CDICFs after ORIFs, while ORIFs performed within 14 days of injury, smoking, hypertension, drinking and female patients made no significant differences
Summary
Open reduction and internal fixations (ORIFs) have been commonly performed in the case of closed displaced intra-articular calcaneal fractures (CDICFs). The aim of our study is to summarise relevant evidence investigating the risk factors for postoperative wound complications of CDICFs following ORIFs. Calcaneal fractures are one of the most common fractures of the hind foot [1]. The rapid growth of operative quantity coincided with a considerable rate of wound complications (2% to 27%) [11,12]. These complications would make patients suffer, but increase hospitalisations and expenses [13].
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