Inpatient soft tissue protocol and wound complications in calcaneus fractures

Operative treatment of calcaneus fractures is associated with the risk of early wound complications. Though accepted practice dictates surgery should be delayed until soft tissues recover from the initial traumatic insult, optimal timing of surgery has not been delineated.

A retrospective chart and radiographic review at a level I trauma center was performed to determine if an aggressive inpatient soft tissue management protocol designed to decrease the time delay from injury to surgery is effective at reducing complications. Ninety-seven patients (17 female, 80 male; mean age, 39.7±14.0 years) with 102 calcaneus fractures treated between October 1995 and January 2005 were identified. Differences in complication rates and quality of reduction between the inpatient and outpatient treatment groups were analyzed. Quality of reduction was determined by measuring postoperative Bohler's angle and posterior facet articular step-off.

Mean time from injury to surgery was 6.2 days for the inpatient group and 10.8 days for the outpatient group (p<0.0001). The overall complication rate was over twice as high in the outpatient group (27 versus 12%, p=0.04) and the serious complication rate was 6.5 times higher when patients were managed as outpatients (9% versus 1%, p=0.09). With the numbers available, there were no significant differences in the quality of reduction obtained at surgery.

This study suggests that this inpatient soft tissue management protocol of calcaneal fractures is a feasible treatment option when a patient is kept in the hospital that offers a reduction in postoperative wound complications while enabling surgery 4 days earlier on average.