Abidi et al identified risk factors associated with complicated wound healing following open reduction and internal fixation (ORIF) of calcaneal fractures. These same risk factors should apply to similar repair of other fractures. The authors are from Thomas Jefferson Hospital in Philadelphia and the University of Pittsburgh.



(1) dehiscence

(2) surgical site infection

(3) osteomyelitis


Risk factors:

(1) single layered closure

(2) high body mass index (BMI)

(3) delay between injury and surgery (mean 10 days), typically treated as an outpatient

(4) smoking cigarettes


Lower risk:

(1) double-layered closure

(2) normal body mass index

(3) admitted shortly after injury with relatively prompt surgery (mean 4.8 days)

(4) nonsmoking



• Possible explanations for lower risk with double-layered closure include: (1) greater number of fascial sutures, (2) less tension on skin edges, (3) less ischemia at the skin edges.

• The mean BMI for patients was 25.7. A normal BMI is < 25 kg per meter square. Most of the patients in the study appear to have had normal weight or Grade I (BMI 25 - 29.9 kg per meter square) obesity (see discussion on BMI in Chapter 2).

• I would imagine a malnourished person with low BMI might be expected to have defects in wound healing and a greater risk of complications.

• Patients with higher BMI tended to have more comminuted fractures. Because of slow wound healing in patients with high BMI and comminuted fractures, sutures were left in for a longer period of time (at least 4 weeks after surgery).

• I was unable to find a cutoff for the BMI to identify higher risk patients. For the implementation I will use BMI >= 27 and comminuted fracture as the risk factor.

• An interval > 5 days between injury and surgery is given in the abstract as the time associated with higher risk.

• Smokers who quit smoking perioperatively did better than those who did not.



• The study was retrospective.


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