Reduced pre-operative skin oxygen saturation predicts revision after open reduction and internal fixation in calcaneal fractures : A reduced pre-operative oxygen saturation as measured by laser-Doppler spectrophotometry in 8 mm depth is associated with revision surgery after open reduction and internal fixation of calcaneal fractures through an extended lateral approach

Int Orthop. 2021 Sep;45(9):2355-2363. doi: 10.1007/s00264-021-05157-4. Epub 2021 Aug 6.


Purpose: To assess which pre-operative parameters correlate with wound revisions after an extended lateral approach to the calcaneus.

Methods: Pre-operative laser-Doppler spectrophotometry was applied in patients undergoing open reduction and internal fixation. The number of wound revisions was recorded during pos-toperative follow-up. Spearman rho analysis was used to identify factors associated with wound revision and receiver operator characteristics curves were calculated for the identified factors.

Results: Thirty-four patients (29 men, 5 women; 37 calcanei) with a mean patient age of 43 ± 14 years were analyzed. The minimal oxygen saturation value at the five measurement locations as well as the minimal value for flow correlated negatively with wound revisions (p value = 0.025 and 0.038, respectively). The area under the curve for the pre-operative minimal value of oxygen saturation was 0.841 (95%CI 0.64-1.00, p = 0.028), indicating a good accuracy as a test to predict wound revision.

Conclusion: A pre-operative oxygen saturation of at least 20.5% across five measurement points along the anticipated incision identified all patients not needing a wound revision (negative predictive value 100%). On the other hand, patients with at least one measurement below 20.5% were at risk for wound revision surgery (sensitivity 100%, specificity 48.5%). NCT01264146.

Keywords: Calcaneal fracture; Foot trauma; Lateral extended approach; Microcirculation; ORIF; Pre-operative diagnostics; Spectrophotometry.

Publication types

  • Clinical Study

MeSH terms

  • Adult
  • Calcaneus* / diagnostic imaging
  • Calcaneus* / surgery
  • Female
  • Fracture Fixation, Internal / adverse effects
  • Fractures, Bone* / surgery
  • Humans
  • Lasers
  • Male
  • Middle Aged
  • Oxygen
  • Reoperation
  • Retrospective Studies
  • Spectrophotometry


  • Oxygen

Associated data