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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

A Letter to the Editor to this article was published on 06 October 2021



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


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.


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.


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%).


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Authors and Affiliations



Matthias Knobe: conceptualization, methodology, formal analysis and investigation, writing—original draft preparation, writing—review and editing, resources, supervision.

Lukas D. Iselin: formal analysis and investigation, writing—original draft preparation.

Bryan J. M. van de Wall: formal analysis and investigation, writing—original draft preparation.

Philipp Lichte: formal analysis and investigation, resources.

Frank Hildebrand: formal analysis and investigation, resources.

Frank J. P. Beeres: methodology, supervision.

Björn-Ch. Link: methodology, supervision.

Boyko Gueorguiev: writing—review and editing, supervision.

Sven Nebelung: Resources, supervision.

Bergita Ganse: conceptualization, methodology, writing—review and editing.

Filippo Migliorini: resources, supervision.

Kajetan Klos: resources, supervision.

Reto Babst: conceptualization, methodology, writing—review and editing, supervision.

Pascal C. Haefeli: formal analysis and investigation, writing—original draft preparation, writing—review and editing.

Corresponding author

Correspondence to Matthias Knobe.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. The local institutional review board (Independent Ethics Committee of RWTH Aachen Faculty of Medicine) approved this prospective cohort study before initiation (decision number EK 346/14).

The study was registered in (number NCT01264146) with the title “Hyperbaric Oxygen Therapy in Calcaneal Intraarticular Fractures: Can it Decrease the Soft-tissue Complication Rate?”.

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All patients gave written informed consent to participate in this study.

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All patients gave consent to publication.

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The authors declare no competing interests.

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Knobe, M., Iselin, L.D., van de Wall, B.J.M. et al. Reduced pre-operative skin oxygen saturation predicts revision after open reduction and internal fixation in calcaneal fractures. International Orthopaedics (SICOT) 45, 2355–2363 (2021).

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  • Foot trauma
  • Calcaneal fracture
  • Microcirculation
  • Spectrophotometry
  • Pre-operative diagnostics
  • ORIF
  • Lateral extended approach