Factors affecting infection after calcaneal fracture fixation

A retrospective study of 178 operatively managed intra-articular calcaneal fractures was undertaken. The primary purpose of the study was to investigate whether delay prior to surgery was related to the prevalence of post-operative deep infection although other factors related to infection were also examined. The deep infection rate was 5.6% but there was no statistical correlation between surgical delay and deep infection. However analysis of the results showed that surgical experience did correlate with deep infection. The infection rate for a group of inexperienced surgeons was 14.3% compared with 2.8% for the most experienced surgeon in the study. Analysis also indicated a trend towards more socially deprived patients having a higher rate of infection but it was only in drug addicts where there was a significantly increased rate of deep infection. Other factors such as smoking, fracture severity and wound closure did not affect the rate of deep infection. Our study shows that delay prior to calcaneal fracture surgery is not associated with a lower infection rate but it is does indicate that surgical experience is important and we believe that these difficult fractures should be treated in specialised centres.