Soft Tissue Complications Following Extensile Lateral Compared with Minimally Invasive Surgical Approaches in the Operative Treatment of Calcaneus Fractures

Overview

Journal Can J Surg

Specialty General Surgery

Date 2022 Nov 23

PMID 36418064

Authors

Gabriel Larose

Ted Tufescu

Ryan Vidal

Ian Laxdal

Affiliations

Soon will be listed here.

Abstract

Background: Extensile lateral (ELA) and minimally invasive surgical (MIS) approaches are commonly used in the operative fixation of calcaneus fractures. The ELA has been the standard of care, but is associated with a high risk of wound complications. Minimally invasive surgical approaches have been developed to reduce these complications.

Methods: We completed a retrospective chart review of 201 patients with calcaneus fractures repaired by either ELA or MIS approaches between 2011 and 2018. We compared the incidence of soft tissue complications, including wound infections (requiring no surgical treatment) and deep infections (requiring surgical intervention), and performed multivariate regression analysis to determine independent risk factors associated with soft tissue complications and reoperation.

Results: The overall incidence of soft tissue complications was 8.1% in the MIS group compared with 28.8% in the ELA group ( = 0.0004). The incidence of patients with a deep infection requiring reoperation was 4.7% in the MIS group compared with 19.2% in the ELA group ( = 0.003). Risk factors of soft tissue complications included the presence of an open fracture (odds ratio [OR] 11.59, 95% confidence intervals [CI] 3.25-44.25) and use of ELA (OR 4.22, 95% CI 1.67-10.90). Risk factors for a deep infection requiring reoperation included the use of ELA (OR 4.43, 95% CI 1.51-13.64) and the presence of an open fracture (OR 4.00, 95% CI 0.91-15.3).

Conclusion: The ELA is associated with an increased incidence of soft tissue complications and reoperation when compared with the MIS approach. The ELA and open fractures were found to be independent risk factors of soft tissue complications and reoperation. Surgeons treating calcaneus fractures should consider using a MIS technique, provided they are able to achieve the goals of surgical management without the ELA.

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References

Peng C, Yuan B, Guo W, Li N, Tian H . Extensile lateral versus sinus tarsi approach for calcaneal fractures: A meta-analysis. Medicine (Baltimore). 2021; 100(31):e26717. PMC: 8341246. DOI: 10.1097/MD.0000000000026717. View

Humphrey J, Woods A, Robinson A . The epidemiology and trends in the surgical management of calcaneal fractures in England between 2000 and 2017. Bone Joint J. 2019; 101-B(2):140-146. DOI: 10.1302/0301-620X.101B2.BJJ-2018-0289.R3. View

Basile A, Albo F, Giai Via A . Comparison Between Sinus Tarsi Approach and Extensile Lateral Approach for Treatment of Closed Displaced Intra-Articular Calcaneal Fractures: A Multicenter Prospective Study. J Foot Ankle Surg. 2016; 55(3):513-21. DOI: 10.1053/j.jfas.2015.11.008. View

Hammond A, Crist B . Percutaneous treatment of high-risk patients with intra-articular calcaneus fractures: a case series. Injury. 2013; 44(11):1483-5. DOI: 10.1016/j.injury.2013.01.033. View

Mehta C, An V, Phan K, Sivakumar B, Kanawati A, Suthersan M . Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis. J Orthop Surg Res. 2018; 13(1):243. PMC: 6154938. DOI: 10.1186/s13018-018-0943-6. View

Eastwood D, Langkamer V, Atkins R . Intra-articular fractures of the calcaneum. Part II: Open reduction and internal fixation by the extended lateral transcalcaneal approach. J Bone Joint Surg Br. 1993; 75(2):189-95. DOI: 10.1302/0301-620X.75B2.8444935. View

Tufescu T, Buckley R . Age, gender, work capability, and worker's compensation in patients with displaced intraarticular calcaneal fractures. J Orthop Trauma. 2001; 15(4):275-9. DOI: 10.1097/00005131-200105000-00007. View

Hsu A, Anderson R, Cohen B . Advances in Surgical Management of Intra-articular Calcaneus Fractures. J Am Acad Orthop Surg. 2015; 23(7):399-407. DOI: 10.5435/JAAOS-D-14-00287. View

Howard J, Buckley R, McCormack R, Pate G, Leighton R, Petrie D . Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma. 2003; 17(4):241-9. DOI: 10.1097/00005131-200304000-00001. View

10.

Wang H, Pei H, Chen M, Wang H . Incidence and predictors of surgical site infection after ORIF in calcaneus fractures, a retrospective cohort study. J Orthop Surg Res. 2018; 13(1):293. PMC: 6245558. DOI: 10.1186/s13018-018-1003-y. View

11.

Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D . Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2002; 84(10):1733-44. DOI: 10.2106/00004623-200210000-00001. View

12.

Ibrahim T, Rowsell M, Rennie W, Brown A, Taylor G, Gregg P . Displaced intra-articular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment. Injury. 2007; 38(7):848-55. DOI: 10.1016/j.injury.2007.01.003. View

13.

Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M . Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ. 2014; 349:g4483. PMC: 4109620. DOI: 10.1136/bmj.g4483. View

14.

Nosewicz T, Dingemans S, Backes M, Luitse J, Goslings J, Schepers T . A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures. Foot Ankle Surg. 2018; 25(5):580-588. DOI: 10.1016/j.fas.2018.08.006. View

15.

Su J, Cao X . Risk factors of wound infection after open reduction and internal fixation of calcaneal fractures. Medicine (Baltimore). 2017; 96(44):e8411. PMC: 5682792. DOI: 10.1097/MD.0000000000008411. View

16.

Tomesen T, Biert J, Frolke J . Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Joint Surg Am. 2011; 93(10):920-8. DOI: 10.2106/JBJS.H.01834. View

17.

Folk J, Starr A, Early J . Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma. 1999; 13(5):369-72. DOI: 10.1097/00005131-199906000-00008. View

18.

Backes M, Schepers T, Beerekamp M, Luitse J, Goslings J, Schep N . Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach. Int Orthop. 2013; 38(4):767-73. PMC: 3971279. DOI: 10.1007/s00264-013-2181-1. View

19.

Agren P, Wretenberg P, Sayed-Noor A . Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2013; 95(15):1351-7. DOI: 10.2106/JBJS.L.00759. View

20.

Court-Brown C, Schmied M, Schmidt M, Schutte B . Factors affecting infection after calcaneal fracture fixation. Injury. 2009; 40(12):1313-5. DOI: 10.1016/j.injury.2009.03.044. View