Soft tissue complications following extensile lateral compared with minimally invasive surgical approaches in the operative treatment of calcaneus fractures

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 (p = 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 (p = 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.