Risk factors for infection and amputation following open, combat-related calcaneal fractures
| Autor: | Cpt Matthew W. Kluk, Cpt Jonathan Dickens, Lt. Col. Wade T. Gordon, Cpt Kelly Kilcoyne, Ltc Scott B. Shawen, Maj Benjamin K. Potter |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Visual analogue scale medicine.medical_treatment Limb salvage Amputation Surgical Fractures Open Injury Severity Score Blast Injuries Fracture Fixation Risk Factors Fracture fixation medicine Humans Orthopedics and Sports Medicine Foot Injuries Iraq War 2003-2011 Survival analysis Pain Measurement Proportional Hazards Models Retrospective Studies Afghan Campaign 2001 Proportional hazards model business.industry Retrospective cohort study General Medicine Recovery of Function Limb Salvage Surgery Calcaneus Treatment Outcome Amputation Multivariate Analysis Wound Infection Female business Follow-Up Studies |
| Zdroj: | The Journal of bone and joint surgery. American volume. 95(5) |
| ISSN: | 1535-1386 |
| Popis: | Background: High-energy open calcaneal fractures are severe injuries complicated by high rates of infection, uncertain functional outcomes, and frequent need for later amputation. Methods: We conducted a retrospective review of 102 consecutive combat-related open calcaneal fractures. Patient demographics, injury mechanisms, fracture and wound characteristics, associated fractures, and methods of fracture fixation were reviewed to determine risk factors for eventual amputation or infection. Results: Eighty-nine patients, with a mean age of twenty-six years, sustained 102 open calcaneal fractures (thirteen bilateral). After a mean follow-up of four years (range, five to ninety-two months), 42% (forty-three limbs) underwent amputation. A delayed amputation (more than twelve weeks from the time of injury) was performed in 15% (fifteen) of 102 open calcaneal fractures. In a multivariate Cox proportional-hazards survival model with time to amputation as the end point, the blast mechanism of injury, plantar wound location, larger size of open wound (in square centimeters), and escalating Gustilo and Anderson classification types (p < 0.05 for all) were predictive of eventual amputation. At the time of the final follow-up, patients who had undergone amputation had lower visual analogue scale scores for pain (2.1 compared with 4.0; p < 0.0001) and higher Tegner activity levels (5.4 compared with 3.5; p < 0.0001) than limb salvage patients. Conclusions: Lower-extremity amputation following open calcaneal fractures is predicted by the injury mechanism, wound location and size, and open fracture type and severity. After short-term follow-up, patients with open calcaneal fractures eventually requiring amputation exhibit improved pain and activity levels compared with patients with continued, ostensibly successful limb salvage. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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