The effect of postoperative immobilization in a plaster of Paris back-slab on the surgical wound-healing following the open reduction and plate and screw fixation of the closed calcaneal fractures: a randomised controlled study
DOI:
https://doi.org/10.18203/2349-2902.isj20232985Keywords:
Calcaneum, Fractures, Wound, Complications, Plating, Reduction, Fixation, ORIFAbstract
Background: Intraarticular calcaneal fractures often need open reduction and internal fixation with plate osteosynthesis. Wound complication is one of the common problems encountered following this. It affects the outcome adversely. Our study was done to assess if a postoperative back-slab can offer any significant difference in the incidence of wound complications.
Methods: Out of 42 patients with unilateral intraarticular calcaneal fractures, 20 were provided postoperative slab and continued for six weeks. The remaining 22 patients were not provided any plaster. All patients were followed-up for two years.
Results: The incidence of wound dehiscence was 2 in the plaster group as well as 8 in the non-plaster group and this was statistically significant (p=0.02). Also, significantly lower heel widening was reported in the plaster group (p=0.03). Although there was no significant difference in the patient-reported outcome (Maryland Foot Score) and the incidence of pain between the two groups, the occurrence of neurological deficit following surgery and the postoperative range of movements were comparable in these two groups.
Conclusions: Thus, it may be concluded that postoperative plaster application for the initial six weeks could be a low-cost yet effective way to reduce wound complications following plate osteosynthesis in intraarticular calcaneal fractures.
Metrics
References
Al-Mudhaffar M, Prasad CVR, Mofidi A. Wound complications following operative fixation of calcaneal fractures. Injury. 2000;31(6):461-4.
Backes M, Schep NWL, Luitse JSK, Carel Goslings J, Schepers T. The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures. Arch Orthop Trauma Surg. 2015;135(8):1045-52.
Bohl DD, Ondeck NT, Samuel AM, Diaz-Collado PJ, Nelson SJ, Basques BA, et al. Demographics, Mechanisms of Injury, and Concurrent Injuries Associated With Calcaneus Fractures: A Study of 14 516 Patients in the American College of Surgeons National Trauma Data Bank. Foot Ankle Spec. 2016;10(5):402-10.
Buckwalter JA. Activity vs. rest in the treatment of bone, soft tissue, and joint injuries. Iowa Orthop J. 1995;15:29-42.
Clare MP, Crawford WS. Managing complications of calcaneus fractures. Foot Ankle Clin. 2017;22(1):105-16.
Dhillon MS, Bali K, Prabhakar S. Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg. 2011;95(3):171-81.
Dias N, Kumar J. A prospective study of the functional outcomes in operative management of intra-articular Calcaneum fractures. Int J Orthop. 2019;5(3):298-303.
Ding L, He Z, Xiao H, Chai L, Xue F. Risk factors for postoperative wound complications of calcaneal fractures following plate fixation. Foot Ankle Int. 2013;34(9):1238-44.
Joshi J, Gupta A, Menon H, Patel M, Lakhani D. Functional outcome of surgically treated sanders types II, III, IV calcaneal fractures: an observational study. J Surg. 2015;2:1-7.
Khedr A, Reda W, Elkalyoby AS, Abdelazeem A. Skin and wound complications after calcaneal fracture fixation. J Orthoplast Surg. 2018;1(1):25-9.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Committee HICPA. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20(4):247-80.
Schepers T, Heetveld MJ, Mulder PGH, Patka P. Clinical outcome scoring of intra-articular calcaneal fractures. J Foot Ankle Surg. 2008;47(3):213-8.