Soft tissue assessment and intervention strategies to prevent postoperative wound complications in closed calcaneal fractures

Abstract

Objective To evaluate the clinical significance of soft tissue assessment and intervention strategies to prevent postoperative wound complications in closed calcaneal fractures. Methods A prospeclive study over a 6-year period was conducted on 207 closed calcaneal fractures in 168 patients who had sought medical treatment in our department from February 2005 through July 2011 for closed calcaneal fractures.There were 152 men with 190 feet involved and 16 women with 17 feet involved.They were aged from 17 to 68 years (average,38.1 years).By Sanders classification,58 feet were of type Ⅱ,124 feet of type Ⅲ and 25 feet of type Ⅳ.A self-developed system of soft tissue assessment was adopted to evaluate the patients.including initial assessment and preoperative assessment, before clinical interventions were adopted accordingly. All patients were randomized into 3 groups who were taken care of by doctors with similar competence according to the same specified protocol.The associations were analyzed between initial soft tissue assessment and time interval from injury to operation, and between initial and preoperative soft tissue assessments and wound complications as well.The postoperative wound complications were compared between groups. Results The incidence of wound complications was 9.2％ in this series.The initial soft tissue assessment was positively correlated with the time interval from injury to operation ( r =2.474,P =0.000),closely associated with the severity of the fracture (x2 =109.829,P =0.000),and significantly associated with the wound prognosis ( P ＜ 0.05).Preoperative soft tissue assessment (including wrinkle test,capillary reaction test and percutaneous partial pressure of oxygen) had significant effects on the incidence of wound complications (x2 =440.961,P =0.000).There was no significant difference between the 3 groups in incidence of wound complications ( P ＞ 0.05). Conclusion It is important to conduct perioperative soft tissue assessments and to take intervention strategies accordingly for closed calcaneal fractures,because they can obbviously reduce the wound complications. Key words: Calcaneus; Fractures, bone; Soft tissue injuries; Postoperative complications