PREVENTION OF POSTOPERATIVE COMPLICATIONS OF CALCANEUS FRACTURES

Abstract

Objective: To optimize prevention of postoperative complications of closed calcaneus fractures (CCF), considering prediction of risk factors (RF) for their development. Methods: The case histories of 490 patients with CCF were studied for the period 2010-2020. Among them there were 25 women (5%), and 465 men (95%), their age ranged from 18 to 70 years; 94% of patients were having recent trauma. Postoperative complications were diagnosed in 183 cases (37%), such as dislocation of metal parts of prosthesis (14%); osteomyelitis of the calcaneus (9%); trophic disorders, particularly skin necrosis (21%); suppuration of the postoperative wound and osteosynthesis zone (51%); fistulae and tendinitis (5%). For the analysis of risk pathology, RFs and the potential for their realization were evaluated. The data reduction procedure was performed using calculation of the correlation coefficient τ. The final assessment of the identified predictors was carried out using the logistic regression method. A protocol for managing patients with risk assessment of complications at each stage has been developed. Results: Statistically significant RFs were revealed, such as edema in the fracture zone on the day of surgery and three days later, odds ratio (OR) =0.07 [CI: 0.015-0.294]; lack of antibiotic prophylaxis before surgery, OR=0.053 [CI: 0.006-0.402]; serious comorbidities, OR=0.252 [CI: 0.108-0.586]; significant changes in laboratory tests, OR=0.137 [CI: 0.056-0.327]; significant changes in the follow up tests, OR=0.12 [CI: 0.038-0.42]; failure to perform an X-ray after surgery, OR=0.095 [CI: 0.031-0.286]; lack of prevention of thromboembolic complications, OR=0.02 [CI: 0.038-0.38]; the quality of the recommendations presented in the discharge summary, OR=0.073 [CI: 0.038-0.142]; hard physical labor, OR=0.009 [CI: 0.002-0.044]. In 45 cases, a patient management protocol was used with risk assessment of complications at each stage, as a result of which no complications were noted in 96% of cases. Conclusion: The presented comprehensive approach to the prevention of complications based on consideration of the individual characteristics of the patient and the use of multidimensional modeling can effectively reduce the incidence of complications and may help even a novice specialist in choosing of proper treatment tactics. Keywords: Fracture of the calcaneus, risk factors, prophylaxis, complications, prognosis.