Contact:
Richard Cantrall 800.235.4855
Doug Cavarocchi
For Release 17 July 1997
Research team identifies risk factors that cause surgical wounds in heel fracture surgeries to take longer to heal
MONTEREY -- Surgical repair of heel bone (calcaneus) fractures can sometimes result in poor wound healing and complications for the patient. Heel bone fractures are the most common fracture encountered in orthopaedic foot and ankle surgery. Researchers at the University of Pittsburgh set out to precisely identify these risk factors and discovered that not only can patient behaviors such as excess weight and smoking increase the possibility of complications, but so can physician behaviors such as the surgeon's technique or whether you are treated in a hospital or as an outpatient in an ambulatory clinic.
If heel fracture patients are admitted to the hospital and treated there shortly after their injury the incidence of wound closure complications drops significantly, according to a study reported today at the American Orthopaedic Foot and Ankle Society's (AOFAS) 13th Annual Summer Meeting. Also, making an "L" shaped incision that allows for double layered suturing (utilizing a flap of skin to weave a more completely closed wound) will reduce the risk of complication and speed wound healing.
"Calcaneal fracture patients who are admitted to the hospital immediately after injury benefit from the controlled environment of the healthcare center," explained Nicholas Abidi, MD, Fellow, Foot and Ankle Surgery, University of Pittsburgh, and an author of this study. "Inpatients get constant care -- their legs are elevated above their hearts, etc. -- and, as a result, they suffer less swelling, are able to be operated on sooner and ultimately heal more quickly with fewer complications then patients treated on an outpatient basis."
Complications can include infections on the surface of the wound and/or more dangerous deep wound infections. Depending on the severity of these complications patients must be treated with antibiotics, surgical removal of infected tissue (debridement), or even lower limb amputation if the infection is extremely severe.
"There has been some debate among surgeons as to how to best treat these types of fractures surgically," continued Dr. Abidi. "This report shows that using a double suture technique provides a much lower incidence of complications for the patient."
Other factors found to have impact on the potential of complications included pre - and post-operative smoking, patient weight, and time between injury and surgery. Of the study subjects who were treated on an outpatient basis, 40 percent admitted to smoking prior to surgery. These patients took significantly longer to heal than those patients who had not used tobacco prior to surgery and were much more likely to suffer complications.
Heavier patients were not only prone to surgical complications and longer recovery times, but their fractures tended to be more severe than their more normal weight counterparts. "These type of fractures occur when a patient suffers a trauma to their heel, generally a fall from a height of ten feet or more. When these heavier patients suffer such a fall, they tend to do more damage to the heel -- fracturing it into a greater number of individual pieces. This can greatly add to recovery time," explained Dr. Abidi.
Time between injury and surgery was also found to play an important role in the success of a patient's recovery. "Our results suggest a need for early admission to the hospital for controlled swelling management and early operative intervention on these patients. Those patients undergoing surgery on or around five days after injury who were managed as inpatients had a lower incidence of wound healing complications and a speedier recovery time, " emphasized Dr. Abidi.
Dr. Abidi was assisted in the collection of data and the writing of this report by Stephen Conti, MD, Sushil Dhawan, MD; and Gary S. Gruen, MD, all of the University of Pittsburgh Medical Center.
Dedicated to advancing research and educational objectives in foot and ankle care, the American Orthopaedic Foot and Ankle Society is the leading organization for orthopaedists with a special interest in foot and ankle problems. - 30 -
Press and patient information available at http://www.aofas.org
RSS