Complications in calcaneal fracture surgery and implant removal

This thesis focuses on postoperative wound complications in calcaneal fracture surgery and implant removal.
The extended lateral approach (ELA) in calcaneal fracture surgery is hampered with high rates of postoperative wound infection (POWI) of up to 25%. No placement of a closed suction drain is associated with the occurrence of POWI. Large differences are found between countries and continents in reports on the incidence of wound complications following the ELA in calcaneal fracture surgery. Use of a standardized definition of wound complications for (calcaneal) fracture surgery is of paramount importance, as well as transparent publication on wound complications. The preferred approach in operative treatment of displaced intra articular calcaneal fractures is the sinus tarsi approach, which has similar anatomical reduction, fewer wound complications and a shorter surgical time compared to the ELA.
Implant removal of the lower extremity is not a straightforward procedure and high rates of POWI of 14.4% are found. A risk factor for the occurrence of an infection following implant removal is an infection following the index procedure. We performed a large multi-center randomized controlled trial to investigate the effectiveness of a single dose of antibiotic prophylaxis prior to implant removal below the knee. We showed no evidence of efficacy and believe there is no place for routine administration of antibiotic prophylaxis prior to implant removal. In addition, we advise to leave implants in place if there is no indication for implant removal.