Abstract
OBJECTIVE: This study aimed to identify risk factors associated with incision complications following the modified "L" approach for calcaneal fractures. METHODS: Data from 100 patients treated with the modified "L" approach for calcaneal fractures between January 2018 and December 2021 were analyzed. These included 52 cases in the poorly healing group and 48 in the well-healing group. Variables such as patient age, sex, body mass index, fracture type (Sanders classification), smoking history, alcohol consumption, diabetes status, timing of surgery, tourniquet use, bone grafting, suture method, and postoperative incision care were evaluated. A nomogram was developed using R software to predict the risk of incision complications, validated through the area under the ROC curve, C-index, and decision curve analysis. RESULTS: Both univariate and multivariate regression analyses identified fracture type, smoking history, diabetes, timing of surgery, and duration of tourniquet application as significant predictors of incision complications. These factors were incorporated into a clinical predictive nomogram. The nomogram's calibration curves demonstrated high accuracy, both internally and externally. The unadjusted concordance indes (C-index) was 0.793 [95% confidence interval (CI), 0.825-0.995], and the area under the curve for the nomogram was 0.7875882. Decision curve analysis confirmed the clinical applicability of the model at a threshold probability of 20-60%. CONCLUSION: We have developed a reliable clinical nomogram to predict the risk factors for incision complications in the modified "L" approach for calcaneal fractures, enhancing decision-making in clinical settings.