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Letters to the Editor to:

Scientific Articles:
Martijn Poeze, Jan P.A.M. Verbruggen, and Peter R.G. Brink
The Relationship Between the Outcome of Operatively Treated Calcaneal Fractures and Institutional Fracture Load. A Systematic Review of the Literature
J Bone Joint Surg Am 2008; 90: 1013-1021 [Abstract] [Full text] [PDF]
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[Read Letter to the Editor] Risk Factors for Infection following Operatively Treated Calcaneus Fractures
Adam Starr, M.D.   (21 May 2008)

Risk Factors for Infection following Operatively Treated Calcaneus Fractures 21 May 2008
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Adam Starr, M.D.,
Physician
University of Texas Southwestern Medical Center, Dallas TX 75390

Send letter to journal:
Re: Risk Factors for Infection following Operatively Treated Calcaneus Fractures

adam.starr{at}utsouthwestern.edu Adam Starr, M.D.

To The Editor:

I read with interest the recent article, “The Relationship Between the Outcome of Operatively Treated Calcaneal Fractures and Institutional Fracture Load, A Systematic Review of the Literature”(1).

I would agree with the authors' conclusion. It seems reasonable that centers that routinely perform open reduction and internal fixation of calcaneus fractures would have a lower rate of infection.

However, some of their results surprised me. They reported, “There was no correlation between the infection rate and the above-mentioned confounding factors [the percentage of patients with joint depression-type fractures as compared with tongue-type fractures, the percentage of patients with a Sanders type-IV fracture, the percentage of patients with a bilateral fracture, the percentage of patients with diabetes or who smoked, the number of surgeons performing the procedures, the mean time to surgery, the mean duration of surgery, the mean postoperative Bohler angle, or the mean duration of follow-up]…”(2).

While I do not care for patients who sustain calcaneus fractures, it seems to me that most papers reporting complications after calcaneus fracture repair have noted that diabetes and smoking are risks factors for infection. I would also suspect that duration of surgery is related to infection risk.

Do the authors believe that a diabetic smoker whose fracture repair takes 8 hours has no greater infection risk than a non-diabetic non-smoker whose surgery is completed in an hour?

The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

Reference:

1. Poeze M, Verbruggen JPAM, Brink PRG. The relationship between the outcome of operatively treated calcaneal fractures and institutional fracture load. A systematic review of the literature. J Bone Joint Surg Am. 2008;90:1013-1021.

2. Poeze M, Verbruggen JPAM, Brink PRG. The relationship between the outcome of operatively treated calcaneal fractures and institutional fracture load. A systematic review of the literature. J Bone Joint Surg Am. 2008;90:1018.