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EPCOT 2023 Park Hours, Early Entry & Extended Evenings: Info & Tips
By Tom Bricker Tips & Tricks 12 Comments
EPCOT's 2023 normal park hours are relatively predictable, with a few exceptions. This guide covers not just normal opening and closing times, but also Early Entry, Extended Evenings, rope drop, different schedules, and more. Plus, tips & tricks for beating the crowds and avoiding times of day when attendance is highest.
The first thing you need to know is that EPCOT park hours will be added to DisneyWorld.com's 5-day calendar on a rolling basis throughout 2023, typically 60 days in advance. Walt Disney World also has a monthly calendar that isn't as easy to find, and this currently has hours released much further in advance.
Walt Disney World typically releases template or placeholder hours before extending those based on attendance and hotel occupancy projections. For a while, the initial release of park hours was almost meaningless, as every single park and date would see extensions. This is less-pronounced of a practice now, and the hours that are released are quite often the final hours. This is especially true at EPCOT.
At present, there isn't a single date on the 2023 calendars where EPCOT's park hours deviate. EPCOT is open from 9 am until 9 pm daily, which includes both the new neighborhoods at the front of the park that were formerly Future World and World Showcase. On some busy weekends and holidays, expect EPCOT to extend its closing time to 10 pm. However, that has yet to occur this year.
Moving forward the opening time to 8 or 8:30 am is also possible. That occurred during busy dates last Spring Break and during other peak periods. One thing not to expect is World Showcase to have a delayed opening time, as it did in the past. Now that Frozen Ever After and Remy's Ratatouille Adventure are two of the most popular attractions in EPCOT, it's safe to assume that World Showcase will continue opening with the front of the park.
Regardless of whether hours are extended, it's common for Harmonious or EPCOT Forever to begin at park closing time. That means 9 pm on evenings when the park closes then. These two nighttime spectaculars each last about 20 minutes, after which there is a mass exodus from EPCOT.
While Magic Kingdom and Hollywood Studios also have huge crowds leaving after the fireworks and Fantasmic, this is usually more pronounced at EPCOT. There's one nighttime spectacular and after it ends, the park is closed. (Magic Kingdom now usually has a gap between the end of its fireworks and park closing time, but when it doesn't, the same problem is even more pronounced there.)
The good news is that you can avoid this crushing crowd simply by lingering. One of the reasons we recommend locations deep in World Showcase in our EPCOT Fireworks Viewing Guide is not just for seeing the show from the best angle, but also because that puts you in a great spot to do a slow stroll out.
Even if you take your time leaving, you'll notice a continued steady stream of guests. This is in large part because it's incredibly common for table service restaurants in World Showcase to offer Advance Dining Reservations right up until park closing at EPCOT. This means you can find ADRs until about 8:50 pm on nights when the park closes at 9 pm. Each of these meals take about an hour, so guests dining at those restaurants are leaving over a full hour after parking closing.
If you're worried about transportation back to your hotel, don't. Officially, transportation to the theme parks begins approximately 2 hours prior to park opening time and runs until approximately 1 hour after the parks close. This is the info you'll find on Walt Disney World's website, and what Cast Members will tell you.
It is true that the Skyliner and boats open and close according to their posted schedules at the pertinent hotels and EPCOT. So the Skyliner actually does close at whatever time indicated on the signage outside the park. However, that's not true of all transportation.
Unofficially, transportation after park closing continues as long as people are inside the park. Sometimes it's closer to 2 hours after the parks close when transportation ends. Cast Members are methodical about clearing the parks and radio to bus drivers to make sure they stick around until all of the stragglers are accounted for.
EPCOT is usually the park that takes the longest to clear. This is due to its mix of its sprawling size and longer meal services, especially when Monsieur Paul and Takumi-Tei are seating guests later. There's also the reality that EPCOT is the "drinking park" and it can take inebriated guests longer to make their way towards the exit.
We have left Walt Disney World theme parks long after park closing many, many times and have never had an issue. If anything, delaying departure as long as possible is the best course of action. You get to enjoy park closing serenity and are more likely to have a bus all to yourself!
One caveat here is for those staying in the Skyliner or Crescent Lake Resorts–if you linger too late at the front of the park, you will not be able to exit out of International Gateway in World Showcase. Instead, you'll be herded towards the bus stops at the front, and have to take a bus–even to the hotels within walking distance of World Showcase. (We've also had this happen to us more than a few times!)
Now let's turn to the expanded EPCOT park hours for guests of on-site hotels. These are Early Entry and Extended Evening Hours, which have replaced Extra Magic Hours in the morning and at night. If you're unfamiliar with the ins and outs of the morning option, learn more in our Guide to Early Entry at Walt Disney World.
Early Entry is pretty beneficial at EPCOT, especially if you're coming from Crescent Lake or the Skyliner and thus entering via International Gateway. If you towards the front of the pack and move quickly, this typically allows you to knock out Remy's Ratatouille Adventure and Frozen Ever After before the EPCOT officially opens. We prefer this over using Genie+ and Lightning Lanes at EPCOT. (See Early Entry v. Genie+ at EPCOT for a full runthrough of how much you can accomplish.)
Extended Evening Hours are typically held at EPCOT on Mondays. This 2-hour offering for select on-site resort guests is hugely advantageous, and is a delightful way to do EPCOT. (See our Guide to Extended Evening Hours at Walt Disney World for more about eligibility and strategy.)
The lower ride count and more obvious top priorities means wait times for the EPCOT headliners don't fall as dramatically as those at Magic Kingdom. On top of that, if even one ride is down, it can throw a real monkey wrench into things. See our Extended Evening Hours at EPCOT Strategy & Report for a look at what we accomplished during one of these nights. Unlike Magic Kingdom and Disney's Hollywood Studios, EPCOT does not offer the 'After Hours' upcharge event.
With the 'special hours' out of the way, let's turn back to a normal day at EPCOT. The first thing you need to do is be up at 7 am (seriously) for the best chance of experiencing Guardians of the Galaxy: Cosmic Rewind, the newest blockbuster attraction at Walt Disney World. This uses a virtual queue, which can be entered at 7 am or 1 pm.
It's not as simple as it might sound. See How to Ride Guardians of Galaxy Cosmic Rewind & Virtual Queue Strategy for tips & tricks to improve your odds of scoring a spot in the virtual queue.
Arriving for regular rope drop (official park opening time) at EPCOT is not the end of the world. You'll still have success and be able to save time at every attraction except Remy's Ratatouille Adventure–so save that for either mid-morning or the end of the night. (See our Ride Guide to Remy's Ratatouille Adventure for the best times to beat the long lines there.)
Most guests enter EPCOT through the front entrance and do this portion of the park first. As such, the front of EPCOT empties out in the evening hours, because guests eat and drink around the World Showcase, and secure spots for the nighttime spectacular. Hitting front-of-park attractions during the last few hours of the day can be a smooth move, especially since it's not imperative that you get a front row view for Harmonious.
It's also worth noting that not all attractions start operating at park opening time. The most notable examples are films in World Showcase and meet & greets. Then there's Impressions de France, which is far and away the best film in EPCOT. This only is shown from 6:30 pm to 8:45 pm–this is essentially a 'secret' aimed at sophisticated audiences in the evening hours.
There are also World Showcase entertainment acts that perform according to schedules, with the bulk of performances occurring during the middle of the day. These add tremendous atmosphere to EPCOT and are worth watching. Rather than actively seeking them out, we recommend stumbling upon this entertainment while perusing World Showcase at your leisure.
Another quirk to the operating hours at EPCOT is festival season. This now encompasses most of the year, save for a handful of weeks in between the end of each event and start of the next one. There are a lot of scheduling quirks for these festivals, but the big thing to know is that the food booths around World Showcase and elsewhere are open from 11 am until park closing.
As for the calendar of these events, the cycle starts with the EPCOT International Festival of the Arts, which usually runs from mid-January until late February. The EPCOT Flower & Garden Festival follows, running from early March until early July. The flagship event, EPCOT's International Food & Wine Festival, goes from mid-July until the weekend before Thanksgiving. Finally, the EPCOT Festival of the Holidays starts about a week after that ends and continues through December 30.
When it comes to the interplay of park strategy & hours, another option is Genie+ and Lightning Lanes at EPCOT. This can be very useful for doing Frozen Ever After, Remy's Ratatouille Adventure, Test Track, and Soarin' Around the World–especially if you don't have access to Early Entry or Extended Evening Hours. The big downside to Genie+ at EPCOT is backtracking–it's a huge park and these 4 headliners are scattered around the park. You will likely end up walking more if using Genie+ and Lightning Lanes.
To that point, for EPCOT strategy & planning insight see the following posts:
1-Day EPCOT Genie+ and Lightning Lanes Plan
1-Day EPCOT Itinerary (NO GENIE+)
EPCOT Genie+ Priorities & Lightning Lane Ride Ranks
Speed Strategy for Genie+ Selections
Ultimately, that should cover what you need to know about park hours at EPCOT. Now it should also be clear why there's a lot to know beyond just the basics that EPCOT currently keeps park hours of 9 am to 9 pm. Many normal guests will see that, show up between 9 am and 10 am, do the park front-to-back, and encounter long lines as a result.
EPCOT is the perfect park for going against the grain, zigging when they zag. If you're able to take advantage of Early Entry, that gives you a tremendous advantage. Ditto if you start in World Showcase or are willing to bounce around to take advantage of crowd flow dynamics at EPCOT. This is Walt Disney World's big "local's park" and can be incredibly congested as a result, but you can typically avoid the crowds with a bit of planning and efficient touring strategy.
What do you think of normal park hours in 2023 at EPCOT? Prefer to arrive first thing for Early Entry, later in the morning, afternoon, or evening? How do you take advantage of the crowd dynamics at EPCOT to avoid long lines? Do you agree or disagree with anything in our guide to park hours at EPCOT? Any questions we can help you answer? Hearing your feedback–even when you disagree with us–is both interesting to us and helpful to other readers, so please share your thoughts below in the comments!
12 Responses to "EPCOT 2023 Park Hours, Early Entry & Extended Evenings: Info & Tips"
Nicole K January 23, 2023
We are staying offsite but are allowed early entry (Drury inn) would it make sense to park at a skyliner hotel so we can enter through international gateway? Also, can anyone park at any Disney hotel or do you have to be a guest or have dinner reservations?
Jared W January 23, 2023
The last time I was there in 2021, the hotels seemed pretty strict about only allowing hotel guests or those with ADRs into the respective hotel parking lots. Even taking an Uber/Lyft they would ask for proof you had a reason to be at the hotel. Swan & Dolphin might have more relaxed rules, but I can't say for show. I would probably just plan on using the regular parking lot and making a beeline for whichever World Showcase ride you are attempting first. For what it's worth, I would recommend Frozen, as Remy is literally right next to the International Gateway and is probably going to be the first thing anyone entering that way tries to do.
Thanks for the advice! We are going during Spring Break so it's going to be crazy busy and we will need to use all strategies to attempt to knock off the headliners!
I'm afraid I do not think you would have any better luck at the Swan or Dolphin. Last month during our stay (at one of these Marriott hotels) some family members drove over to visit for an hour or so and I asked about guest parking passes. Neither the Swan nor Swan Reserve offered those as options. Parking only for guest vehicles or, for Reserve, mini-golfers. Maybe consider an Uber dropoff or opt for Genie+ if you can make 7am reservations with a res at that hotel.
carolCap January 22, 2023
The evening extended hours at Epcot post didn't mention guardians but your park hours post mentioned if you are in the front of the park at the end of the night you could have trouble getting back into world showcase and might have to take a bus back to Epcot resorts.
I'm scheduled to be at dolphin and do Epcot extended on April 3 and am now worried I could get late guardians and be stopped from walking back to my hotel.
Has anybody run into this problem? Might cast members at guardian be flexible about your queue time if you indicate your concern this could be problem getting back to world showcase and your hotel? Thank you.
Tom Bricker January 22, 2023
You have no reason to be worried!
The only time you'll have to take a bus to Crescent Lake or Skyliner resorts is if you're really dragging your feet or have a late dinner (and take your time). In my case, it's lingering to take photos. If you're just doing attractions, you'll be fine–even if you're among the last off of Cosmic Rewind.
Thank you. That's a big relief
I visited Epcot a few days before Xmas and stayed at the Swan Reserve. I put in for Guardians queue a few seconds after 7, before making a Genie+ reservation, and we got a boarding group with estimated call time of like 10:30am. As it happened, our group was called prior to 10, but for this and G+ reservations across five days we had zero problems using them after the specified time window. I never had luck asking to use a reservation early, fwiw, but I am not sure you should worry too much.
Carol_Cap January 22, 2023
Thanks. I couldn't find any discussion of how good my odds were during extended hours at Epcot ,where you try at 6 pm for guardians during 9-11. My first concern was not getting guardians at all; but then when Tom mentioned possibly getting stuck and not being able to reenter showcase I worried about getting an 11 pm boarding group.
Thanks to you and Tom for helping damper my concerns.
Brighter January 22, 2023
last month, my boarding group was called while my daughter was just about to sing with her choir in Candlelight Processional and I thought oh, well, better luck next time. But I asked at the entrance, about 2.5 hours after I was called and the CMs could not have been nicer. They even let her ride with me!
wwcpd January 22, 2023
This article and the similar ones for the other parks are perfect timing for me, as we're arriving at DW next Sunday, for a visit that's been rescheduled 3 times and I've been planning for over 3 years! So, just wanted to say Thank You.


Jonas Blixt of Sweden hits his tee shot on the 12th hole during the third round of the 2014 Masters Tournament at Augusta National Golf Club on April 12, 2014 in Augusta, Georgia.
AUGUSTA, United States - Hopes of a first European winner at the Masters in 15 years were alive after Saturday's third round with five players under par and within range of joint leaders Jordan Spieth and Bubba Watson.
Leading the way is Swedish rookie Jonas Blixt, who has surprised many at Augusta National this week with the quality of his golf, and Spain's Miguel Angel Jimenez, who has surprised many that he is still competitive at 50.
But the real threat may come from further down the leaderboard in the shape of England's Lee Westwood, who at 40 has played in 63 major tournaments and has yet to win one. That is the most of any active player, just one ahead of Jimenez and two ahead of Sergio Garcia.
Westwood, who was runner-up in the 2010 Masters and tied for third in 2012, moved up the leaderboard Saturday with a two under 70 that left him three strokes off the lead.
Asked if he felt he had a realistic chance of finally bagging that elusive first major win, Westwood replied: "Oh, very much so, yeah.
"Anywhere within five, even six shots of the lead going into the final round of the Masters is given a good chance, especially with the way the golf course is playing out here.
"Kind of on the knife edges of the greens. It's getting faster and firmer."
Experience of the course will be crucial, he believes and that he has in abundance, having played in 14 Masters with an unbroken record going back to 2005.
"Augusta is one of those places where I feel like I can get around," he said. "And I felt like I know how to get around here, even if I'm maybe not on my game. But I've hit the ball well this week and that's why I'm in contention."
Ryder Cup teammate and fellow Englishman Justin Rose is also still in the hunt after a 69 left him four strokes of the lead.
Rose struggled in the first round when he had a 76, but his game has been improving since then and he staked his claim to a second major title afer his US Open win of last year with a brace of eagles at the third and 13th holes.
"Third hole, obviously a bonus coming off the back of a four?putt. Hit driver off the tee, wedged it up. It's a blind shot, but obviously I could tell by the crowd that it went in.
"At 13, I hit a great drive, drew driver around the corner. Hit an awesome four-iron at the pin, which began to funnel a bit to the right, but made about a 25-footer there for an eagle.
"There's a lot of players I think going to be in with a chance tomorrow. Anybody under par going into tomorrow has a good shot."
But if the mood was upbeat for Westwood and Rose, it was less the case for a third Englishman, Ian Poulter, who made a charge early in the day only to fall away again down the back nine as he finished at level par.
"Four-under for the day and cruising. And should have been a couple more, as well. Made a couple of mistakes. I didn't take advantage of the par-5s on the back nine from perfect position.
"I'm pissed. I'm really pissed and I should be pissed. Four-under par out there on the golf course, I'm playing some phenomenal golf. Anyone would be pissed."


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Teen Faces Hate Crime Charges For Putting 'Slave For Sale' Ad On Craigslist
posted by Bill Galluccio - Nov 21, 2019
An Illinois teen from the Chicago suburb of Naperville is facing hate crime charges because he allegedly posted a "slave for sale" ad on Craigslist. The 14-year-old student, who has not been identified due to his age, reportedly used a photo of one of his classmates along with racial slurs when he posted the ad online. When word of the ad spread throughout the school, students started laughing at the victim, and one person reportedly told him, "I'll buy you for a dollar."
The ad remained online for four days before local authorities became aware of the post. The teen was taken into custody and was charged as a juvenile with two counts of a hate crime, both felonies, and one count of disorderly conduct, a misdemeanor.
"The allegations against the juvenile in this case are beyond disturbing," DuPage County State's Attorney Robert B. Berlin said. "Hate crimes have no place in our society and will not be tolerated in DuPage County."
The victim's mother, Tamara Wallace, said that the two boys used to be friends, but told WGN-TV that changed when the teen started making racist comments towards her son.
"They used to be friends. They are not anymore. The moment he started teasing my son, calling him dumb, making fun of his skin color, saying 'shut up slave' last October," the mother said. "They are not friends anymore."
The teen was given an in-school suspension and will have a meeting with the victim and the school's principal to apologize for his actions.

redpajama_set_name: RedPajamaCommonCrawl


The service department is excellent. I'm very impressed with Mo, service advisor who took care of every need when my panamera was in the shop and extremely blessed that when I asked for a recommendation on someone is sales he referred Alycia. Her knowledge, enthusiasm and passion for what she does is top notch. I will definitely recommend both Mo and Alycia for anyone looking to purchase a porsche or for maintenance of their vehicle.


Welcome. You have found a website that will serve as a reference in your search for a better way to navigate your city and as a place to vent your frustrations at the chaos around you. Whether you travel by car, by bicycle or by foot this website is designed for you. Please select a city, if your city isn't listed and it should be, please request an account below. We will soon be allowing people to sign up for an account and begin logging the worst intersections in their cities. We hope that someday this tool can even help change the way our cities are planned, by providing a reference for what works and what doesn't. Enjoy!
To request an account please use this form. Accounts are limited and discretionary, please tell us what city you live in and why you want an account.


Arrival. Transfer to the hotel. Welcome to Europe!!!. Transfer to hotel and free time. You will receive information about the start of the circuit during the afternoon, or you can check the informative panels in the hotel reception area.
Admire the fantastic landscapes. Cable car included to Grindelwald first. Lunch included. Today´s stage has beautiful landscapes with high mountains and lakes. Breathtaking scenery. GRINDELWALD where we will have time for a coffee before taking the cable car (ticket included) up to Grindelwald first. We will walk along the path (30 minutes) in which we shall be able to take the ¨footbridge over the empty¨ among the fantastic scenery enjoying glaciers around us. Lunch included (vegetarian option available). After that we continue through the region of Interlaken to LUCERNE, one of the most beautiful cities in Switzerland. Time at the end of the day to stroll, enjoy the city and dine before returning to the hotel in Zurich.
Explore Bern, the capital city of Switzerland. Indian dinner included. Embark on a scenic journey to BERN, capital city of the confederation built around a bend in the Aare River, with its medieval architecture preserved in the Old Town. Time to take a stroll and breathe in the fresh air. Next, we journey to France. Enjoy beautiful lake views on our trip to Paris. We arrive in the evening.
City tour in Paris. Boat ride along the Seine. Climb to the second floor of the Eiffel Tower. Evening transfer. Indian dinner included. A scenic guided tour to discover the history, main boulevards and the breathtaking monuments of Paris. We end the visit at the Eiffel Tower area. You will have the opportunity to climb up to the second floor of this remarkable metal monument (ticket included). End your visit with a boat cruise along the River Seine, which divides the north of Paris from the south. Enjoy a free afternoon to explore as you choose. Sometimes queues to climb the Eiffel Tower are long. For organizational reasons, if deemed appropriate, the climb can be made at a different moment of the day. At sunset enjoy Indian dinner in the city of lights. Return to hotel.
Free time in the City of Lights. Indian dinner included. We go to the centre of Paris, to the area of the Louvre Museum. Free time. If you wish we can accompany you to Benlux, one of the most complete and best-known perfumeries in Paris. It will be offered for travellers who are interested, an optional excursion to enjoy in EURODISNEY. Rest of the day free. Indian dinner included.
Ticket admission: 2nd Floor Eiffel Tower in Paris.


As one regular reader of this blog will remind the other, back in September 2009 I did an interview for "Reader's Digest" Magazine, about both the book and the website it was based on. The article appeared in their December 2009 edition, and today I'm delighted to say they have very kindly given permission for me to share it online.* It can be viewed by clicking here (and no doubt Mr P will tidy it up and provide an even easier link in due course). There is a witty cartoon to accompany it… but obtaining permission to use it is proving trickier. Either watch this space, or visit your dentist more often.
In other technological advances, I've begun playing with "Photoshop Elements 7," and the first fruits of my attempts at an "animated" banner to publicise the book are online. The problems of balancing the space available at the top of the page with something which might catch the eye have proved interesting; and I'm beginning to understand why those in advertising charge what they do.
* Many, many thanks to The Reader's Digest Association Ltd (particularly Haze) for granting us kind permission to reproduce the article online.


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American Sign Language Bible Translation Completed after 39 Years
After 39 years, a translation of the Bible in American Sign Language has been completed.
The final books needed, Isaiah, Jeremiah and Ezekiel, were completed this fall.
According to Christianity Today, work on translating the Bible into ASL started in 1981 with Duane King, a minister in the Independent Christian Church.
King, who is hearing, had learned to sign after meeting a deaf Christian couple in 1970. The couple told King they avoided going to church because they did not understand what was going on. King said he felt he needed to help the deaf community.
King and his wife, Peggy, then started a church and a mission for the deaf in Iowa. In 1981, King started work on an ASL Bible.
"Most hearing people don't understand how difficult it is to learn to read what you cannot hear," King said in 2019. "Deaf people rely so much on their eyesight that they want everything to be tangible—they want to be able to see everything."
Translation to sign language begins with the adaptation of the English words to a "front translation," a version that uses a word order and vocabulary that corresponds to sign language.
Harold Noe, a Hebrew and Greek scholar who worked with Deaf Missions, said in an interview in 2004 that the translation can be difficult because ASL has a different syntax than English.
"The same sign used for `resurrection' is the sign for `stand up,'" Noe said. "I recall working with some children at the Iowa School for the Deaf. When I signed that sign for resurrection, the kids would stand up. I kept saying, `No, it's not time to go yet.'"
Deaf Missions also produces devotionals for the deaf and offers classes.
For more information on Deaf Missions and to watch the ASL videos, visit the organization's website at deafmissions.org.
Photo courtesy: ©Getty Images/Syahrir Maulana
Christian Killed in Fulani Herdsmen Ambush in North-Central Nigeria
Christian Killed in Fulani Herdsmen Ambush in North-Central Nigeria Tuesday, September 22, 2020


Nominalization – Style #5 | I wrote a book. Now what?
Last but not least for the category of STYLE. I'm wordy so this one is important to me. I tend to add unnecessary words where they're unneeded. I find them where I could easily be restructured to become a simpler sentence. I had a count of 127 errors in writing Style. If you missed a previous blog, you can click on the purple link here that is crossed out to see that blog post.
In the last blog, I talked about Inflated Phrase and Wordiness. Nominalization is similar to them. I only had one incident of Nominalization show up.
Usually, we use verbs to talk about actions. But many verbs have noun counterparts that refer to actions. These noun counterparts are called nominalizations. Using nominalizations often results in long phrases like make a decision instead of decide or put forward a suggestion instead of suggest. These phrases can weigh down your writing and make it harder for your readers to understand what you're saying. A single verb is usually more expressive than a phrase.
The character is actually speaking to a group of people so I would need to keep that in mind when correcting this.
This would actually work for a group or just one person. This is very similar to wordiness and inflated phrase.
Since I only have one of my own examples to use I'll give a couple more.
Wordy This instruction may cause confusion for our students.
Concise This instruction may confuse our students.
Wordy Tony gave his lover a glance.
Concise Tony glanced at his lover.
Simplify your writing to make it more clear. While it may 'feel' like you're being professional or intelligent it's unnecessary to complicate things.
Your so welcome, it's so true! Your advice is excellent and well thought out not to mention generously shared.
Not sure if you'll get this message or not, but all my comments to you recently have been filtered to the 5pam folder. You will need to mark them as safe.
I sent you a couple of messages. First was to thank you for participating in the daily prompt. Also to let you know you can put the prompt URL in the body of your post and save the title for the post title. I have a page explaining how to do that. Also, I've been putting your post's URL in the comment line of the Prompts comment lines so other bloggers can visit your post and enjoy too.
Awe, thank you. I'll get Adam to look and then show me. I'm better being shown, cause I can put it into memory, which so far hasn't failed me, smirk smirk. I am thrilled you're doing this.


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Surf in Costa Rica - Beaches, Spots
The Surfer's Guide to Costa Rica - Descriptions of Costa Rican surf spots, distances, tides, and photos.
Surf - Open Pro Women and Men 2016
Open PRO 2016 / World Surf League / Essential Costa Rica
World Surf Championship in Costa Rica 2009
Surfing Bikinis - Surfing Republica - Costa Rica
Surfing in Costa Rica - Learn about the surfing opportunities in beautiful Costa Rica
Surfing Playa Hermosa Beach Costa Rica - April 19 to 24 2016 - Daily surf report video for Playa Hermosa, Costa Rica.
Tamarindo Beach
Surfing Uvita, Dominical, Costa Rica - Marino Ballena National Park
Surfing in Costa Rica.
Costa Rica is a paradise among surfers, with 755 miles of coastline with great surf spots plenty of waves with big breaks, with tubes and pipelines in some places. On the two oceans are good break posibilities, and allways with comfortable water temperature on all seasons. Friendly people, beautiful scenery, corals waters, accommodations and restaurants are a big plus.
Guanacaste -
North Pacific Coast / Location / Break description
Best Surf Season: November through March
How to get there by bus: Tamarindo and Santa Cruz> Buses Alfaro: 200 meters north of Hospital San Juan de Dios. Phone:(506) 222-2750 Location
Liberia> Buses Pulmitan: 14th street, 1st and 3rd avenue. Phone: (506)222-1650
Potrero Grande - Located 270 kms from San Jose near "El Coco" beach, but with no road access. Access only by boat from playas del coco or playa Ocotal. No facilities. Take with you, all your supplies for camping.
A right point break, with very fast and hollow waves. Nice big tubular wave, if the swell is on.
Playa Naranjo - Located in the national park of Santa Rosa, you must pay the entrance fee (about $10). A good four-wheel-drive vehicle is recommended, but from April to October the road is closed because the rainy season leaves the road impassable, but you can leave your car at the entrance and go walking or take a boat from El Coco or Ocotal. There are no facilities and you must go totally prepared for camping. Accessible also by boat.
The best surf point is located by beach called "Roca Bruja" which means Witch's Rock.
Very long break with strong offshore winds from december to march. Long tube ride with one of the greatest beach breaks in the country.
Playa Grande - Accessible by road only at 20 minutes north of Tamarindo. Very consistent beach break.
Playa Tamarindo - Accessible by road and good base for surfing nearby beaches. Best spots near 'Pico Pequeño' a rocky point in front of the hotel Tamarindo, Good beach break. An excellent river mouth break near 'El Estero'.
Playa Langosta - Located I km south of Tamarindo Beach. - A right and left river mouth break
Avellanas - Located 10 km south of Tamarindo and 4wd recommended on winter. You can surf all along the beach. The southern part has a left point break. Good left breaks and somes pipes in the middle of the beach; and can surf the river mouth with nice rights and lefts in this northern part. Nice white sand beach but with few places to stay or camp.
Very good beach break with rights and lefts and great tubulars in near the rocky points.
Playa Negra - Is one of the best breaks in the country. Located 5 km south of playa Avellanas. - Located between Avellanas and Santa Cruz. A nice rocky point right, large and tubular waves. In recent times the beach has been invaded by surfers from all over the world, making it a crowded point from time to time.
A very nice right point break with large, tubular and fast waves further to the south.
Nosara Beach - Nosara is a little town with airport and accommodations about 350 kms from San Jose. You go from San Jose to Nicoya and from there to Nosara. It takes approx. 5 hours to get there. Following the road there is a lot of good breaks with no names.
Good beach break, with lefts and rights.
Playa Coyote, Manzanillo - A 4 wd vehicle is recommended. Now you can find a lot of places to stay.
Beach breaks, with very consistent lefts and rights and several points.
Mal Pais - Nice rights and lefts. You can find three excellent points at this beach, as well as accommodations and restaurants in a wonderful place to stay. Also it's near a great National Park called Cabo Blanco that has some points of its own.
Cabo Blanco National Park - If you go walking by the beach in the park, you'll find nice rocky points, but it can be dangerous because it's not a well-known area. Always surf with someone else for safety.
Puntarenas - Central Pacific Coast - Best Surf Season: April thru November
How to get there by bus: Boca Barranca & Puntarenas: From the Red Cross central, 100 meters west, 250 south
Jacó: Transporte Jacó € 223-1109 € 16th street, 1st avenue
Boca Barranca - One of the best waves the second longest ride of the country. Located in the south of Puntarenas, about 100 kms of San Jose with excellent access, paved road and many places to stay. When it's good, it's a great wave, but it's not good all the time. Boca Barranca and any other nearby beachs are no contaminated. but the dark water during rainy season sometimes scares off many. Many places to stay, and when its good you'll ride about 1km, then walk by the beach to the point.
A river mouth with an excellent and very long left.
Puerto Caldera - Located 3 km south of Boca Barranca, Puntarenas. Better at low tide and with large swell. No accommodations nearby. If you ask the people there you can pass to other rocky points like "Tepezcoelollo", but sometimes they won't let you in. The water could be polluted because of ships.
Very good and powerful left at the port.
Playa Tivives - The entrance is at the coastal highway, south of Caldera. The beach break gets rights and lefts with a lot of current, and at the river mouth you can find the perfect left (sometimes tubular). There are no accommodations, but you can camp, and there are a couple of restaurants for supplies.
Good beach breaks with rights and lefts and river-mouth left
Valor - This Rocky point located south of Tivives gets very good and very big. You'll have to cross the river paddling, then walk on trails and you're there.
Playa Escondida - Accessible by land I you are a member of the beach club there (fresh water shower on the beach for member and guests), or by taxi boat to the cove to the south. You can rent a boat from playa Jaco or playa Herradura. The road is private, so you'll either need a pass or have to get a boat from Playa Herradura (5 dollars p. p), Lately this beach has been really crowded, but you still can catch a wave or two if the swell is on. This is a tubular ride, if you don't make it you can get cut with the reef, so its not a beginners wave.
Very powerful reef break.Excellent point break that peaks up forming a very good left and a surfable right.
Playa Jaco - Playa Jaco is growing tourism center, approximately 2 hours from San Jose (140 km), and the waves are not always dependable, but there is a lot of hotels, camp grounds and restaurants. Fun beach break, you can surf along the beach. This town is full of surfers, and you'll find all the accommodations and entertainment you want. It's a nice place to stay because its near a lot of good points, and you can buy or repair boards. You'll also find all the information you need about points and current swells.
Good beach break. Tends to close out when it gets over 5 feet.
Roca Loca - Located 1.5 km south of playa Jaco. To get the point, you will have to climb a small hill. Right break. Located on the way to Playa Hermosa about 1. 5KM south of Jaco. When you see it you have to descend a hill. It's not a safe place (about 5 years ago a surfer died there). Surrounded by rocks.
A rocky point with rights that break over submerged rocks.
Playa Hermosa and Others - Located at the south of Jaco (about 10 min). This long stretch of break peaks working any given day, but the preferred sand bar is located in front of a large tree known as the Almendro. The waves conditions are generally best when the tide is rising. Don½t forget the tip the kids who open the gate for your car. Long beach full of points. This is one of the most crowded beaches (some weekends you can count 100+ surfers along the beach) because it's near Jaco and San Jose. This beach is very constant and it throws tubes and perfect waves when the conditions are right.
Very strong and consistent beach break.
Esterillos Este, Esterillos Oeste. - the points located very close to playa Hermosa, making easy access and many nearby accommodations. The wave conditions are very similar to those of playa Hermosa. Beach breaks with few accommodations & restaurant nearby, nice place to camp. The points are located south of Hermosa Beach along the coastal highway.
Beach breaks, good wave forms.
Bejuco Good beach break, located south of Esterillo Este. Few accommodations nearby.
Boca Damas Located north of Quepos, good rights and lefts in a river mouth. Ask the locals if you can't find it. You can walk in from Quepos.
South Pacific Coast - Best Surf Season: April thru November
How to get there by bus: Quepos: Transporte Morales Located at Central avenue, 16th and 18th streets. Phone: 223-5587
Golfito: Tracopa € 223-7685 € 1st street, 18th avenue
San Isidro del General: 223-3577 € 16th street, 1st & 3rd avenue
Quepos - This small left `point is found at the river mouth in the city of Quepos, easy access with many restaurants and accommodations. Needs a large swell to work well. Lots of restaurants and hotels. This town is popular, so you'll find good night life too.
Left break located front of the town of Quepos.
Playita - Manuel Antonio - This area needs larger swell for the surf to show. Lefts and rights beach break, located north of Manuel Antonio. This break needs a large swell or it's too small for good surfing.
Beach break, lefts and rights with good shape.
Playa El Rey - Best access to get there is taking the road to playa Dominical, 25 minutes from Quepos, in Roncador go right 11 kms and you will be there. No accommodations but a good place for camping and surfing; you'll have to ask the locals from Quepos how to get there, because the entrance is in a palm plantation.
Beach break with right and left, a lot like Playa Hermosa.
Playa Dominical - Beautiful landscapes and very tropical. Hotels and restaurants near spots. If you're lucky enough you will surf along with the dolphins in a wonderful experience, they'll jump along right next to you. A good place to stay. Here you'll surf rights and lefts; like a beach break but some rocks below. Lots of restaurants and places to stay.
Great and strong beach break with lefts and rights.
Drake's Bay - Remote Area Accessible only by boat. Boca del Rio Sierpe, is another place with exciting potential for the same kind of waves . Corcovado national park is an adjacent kingdom of lush, tropical wilderness, approximately 1-1/2 hours by boat. This point is located at Peninsula de Osa, and you'll have to take a boat and bring all your things, because there are no accommodations. This area is full of points, but because of its difficult access it's not a well known area.
This remote break offers long, powerful waves when the swell is running.
Back Wash - Located South of Matapalo, very nice right rocky point, wonderful white sand beach. When Matapalo is too big to surf, Backwash is the place to go; it has huge swells. No accommodations at the beach, but you'll find some places nearby, but they can be expensive, so be prepared.
Pan Dulce - Located South of Backwash, this would be the longest left of this three points (Matapalo, Backwash, Pan Dulce), but it's only surfable with big swells -- if you're lucky you can have a great time, but if you're not, head for Backwash or Matapalo.
Pavones - Excellent left point, considered one of the longest in the world. Good shape and very fast. It is located 400 kms from San Jose (8 hours by car). Bring camping gear if you wish to hang there. Out on the peninsula across Pavones, a half-hour boat ride away, is reputedly a series pf right points the equivalent of Pavones½world class lefts. This wave is considered one of the longest in the world, about 1. 3 KM when the conditions are good. Here you'll find plenty of surfer accommodations, restaurants, and places to stay or camp, but because this beach is famous it's sometimes very crowded. About 400KM of San Jose, you can get there from Golfito, or via the southern border (Panama). If you go by Golfito, the ferry closes at 5:30PM.
Very long left at mouth of Golfo Dulce.
Punta Banco - Located 2 miles south of Pavones by road. Good place to go when Pavones is too small, or crowded. Accommodations nearby.
Reef breaks with rights and lefts.
Matapalo - located in front of Pavones, at tip of Osa Peninsula. You can get there by road from Pavones or by car from Golfito. A rocky point and also a rocky way out; be careful going out because the wave can push you into the shore rocks. You can get there by boat (From Pavones, Puerto Jimenez) or by road from Puerto Jimenez (20 minutes). Few accommodations nearby, and no restaurant. When it gets big you better have a big board or go surfing Back Wash. In some cases the local families can give you food -- you'll have to ask them if you didn't bring your stuff.
Excellent and powerfull right point break. Perfect waves.
Punta Burica - Difficult access only by boat. The last beach south on the Pacific coast, there's no road, so you'll have to take a boat and ride this great break alone with your friends.
Very remote reef breaks.
The Caribbean Coast - Best Surf Season: November thru March -
How to get there by bus: Limon: Coopelimon € 223-7811 € In front of the Atlantic station.
Puerto Viejo: MEPE S.A. € 257-8129 € 250 meters north of Hotel Europa
Puerto Viejo (Salsa Brava)
A very thick and voluminous wave that comes from deep water onto a shallow reef, also called "salsa", for its juice power. This place gets very big and tubular (legitimate big wave). Salsa is approximately a 3-1/2 hour drive from San Jose and there is a restaurant and accommodation close to the point. Costa Rica's most powerful wave, tubular and very dangerous because if you don't make it, you will visit your friend "Salsa Reef". The break is called Salsa Brava and is located front of the town of Puerto Viejo where you can find hotels, camping, restaurants and night life Caribbean-style. Great place to surf but when the swell arrives there's a big crowd waiting for the tubes, and some get stuck in the reef, so bring a big board and always stay focused. Fast right over coral reef, plenty of hotels and restaurants.
Playa Cocles The beach is located just south of Puerto Viejo , and you can go walking by the beach in a trail with beautiful trees and birds along the way, or go by car and stay in the accommodations in front of the beach.
Good right beach break.
Manzanillo Here you find rustic lodging and typical food. Located close to an unpaved road, and easy to get to. Located 20 KM south of Puerto Viejo, Limon. There are few accommodations nearby. The break is in the Gandoca-Manznillo National Park.
Very fast and good right point beach break only when big, .
Cahuita: Black Beach Cahuita is a National Park, is North from Puerto Viejo with an excellent beach break, not well known and therefore not heavily visited for surfing. Nevertheless, there are waves all year round. Usually it gets good with big swells, so some people escape crowded Salsa and catch some nice waves nearby. You will find accommodations and beautiful trails along the coast and entering the mountains.
Westfalia - Extending south from limon along the road from Limon to Cahuita National Park. It can be dangerous because of the strong currents, so stay out if it's big.
Lefts and rights Beach breaks that tend to close out where the swell gets too big.
Playa Bonita - Located 5 km north of limon (downtown). Left over reef off popular beach just north of Limon City. Cahuita: Beach break on Black Beach, near hotels and restaurants. Used to be one of the best waves, but the earthquake raised the land here, and now you'll get good waves only few times a year. There are accommodations and the beach is located north of Limon city (5KM).
A point/reef break known for its very thick, powerful and dangerous left.
Portete - A small bay located north of playa Bonita. With a right working off the southerly point. Since it is close to limon, you will find easy access.
Right point break, located north of Playa Bonita, accommodations nearby.
Isla Uvita - An island off the coast of Limon. Here you will find a good left. Isla Uvita is about a 20 minutes boat ride from Limon with passage available at certain times of the year. Christopher Columbus came to this little island when he first visited Costa Rica in his fourth trip. The Island is in front of Limon, and you have to take a boat (five dollars p. p. ) at Limon, or at Piuta, a nearby town to the north. On the island you will find no accommodations or water, so bring all your stuff, because if you want you can camp in the area.
Uvita has an impressive left, which can get big and dangerous, so ask the locals how to get out from the point to the island, because if you go straight you can have trouble with the reef. You'll have to do a half moon and stay out of the inside when you are going out or when you are caught by a big set.
Good beach break waves
The North Caribbean Coast - accessible via Tortuguero channels or by private plane. You can rent a boat to take you through the channels near Puerto Moin, 15 km north of playa Bonita. There are beach breaks along the way to Nicaragua, but there are no roads, so you have to go by boat or private plane. There are few accommodations but if you have the contact you can surf virgin beaches along with your friends.
Playa Grande - Good beach break, very good from December to February. You can see turtles nesting at night. Hotels and restaurants nearby, sometimes it gets very good with big tubes. Normally you'll find good waves as long as the wind is to the north.
El Estero - A river mouth; right break at the Tamarindo Bay entrance, very long ride but very crowded because the accommodations are very good at Tamarindo. From the river mouth you can go walking to Playa Grande or to the other points nearby Tamarindo. When the swell is on there are waves for everyone.
Pico Pequeño - A rocky point with a right in front of Hotel Tamarindo. It's very good when tere are big swells but normally they are small.
Langosta - A river mouth right, located 1 mile south of Tamarindo. There are some rocks underwater, so don't think Langosta is a beach break. Beautiful white sand beaches along the way.
La Piedra del Zapo - A right point break, located south from Langosta, better be low tide to cross the river easily.
Little Hawaii - Located north of Avellanas. You can see it breaking from the river mouth; you can go walking or by car but be careful because a lot of people has their rented cars taken by the river, so it's recommended to enter by walking on the beach instead.
Callejones - Located south of Playa Negra. Good right point break very similar to Negra, and people like to go there when Playa Negra is crowded.
Junquillal - A point break, breaking at high tide. Located south of Playa Negra. You can get there by walking on the beach.
Punta Guiones - Big wave beach break. There are places to stay but not in front of the beach; there are some tree houses at the beach to help you stay out of the rain or sun, and you can camp there if you bring all your stuff. You can buy in Nosara.
Puerto Carrillo - Has a beach break with regular size and a wonderful white sand beach. Located south of Samara.
Camaronal - Located south of Puerto Carrillo. Nice beach break but surrounded by rocks; it gets very big and the set comes in constantly. Nice place to camp, but there are no accommodations at this beach.
The Surfer's Guide to Costa Rica - Guide to surfing in Costa Rica.
Surfing Pavones Costa Rica - Mar 30 to Apr 01 2016 - On Beach 2016
Surfing at Tamarindo, Costa Rica - More sick waves. - rovercamsurf 1/28/14
Surfing Playa Hermosa Costa Rica -
Surfrider Foundation - dedicated to protecting the oceans, waves, and beaches.
Surfing Costa Rica Surf camps , lessons , packages , surf report , transportation and more
Costa Rica surf 2020
Good-Epic: Caribbean Costa Rica, January 10th Surfline.com Surf News
Want To Live Like The Blue Zones? Costa Rica Can Show You How. Forbes
Costa Rica Interested in Organizing 2020 World Surf Championship The Costa Rica Star
The Last 12 Olympic Qualifiers Will Be Crowned in El Salvador Surfline.com Surf News


text:
Q: What factors would cause me to favor inheritence over composition in a small database? I have identified two choices for how to model addresses in my corporate entity database.
Method 1: inheritance
Table 1: Addresses [data table, primary key = (id)]
id (integer) - primary key
subclass (string) - describing which subclass table to look in

Table 2: AustralianAddresses [subset table, primary key = (address_id)]
address_id (integer) - foreign key (Addresses.id)
<< other Australia-specific fields >>

Table 3: UKAddresses [subset table, primary key = (address_id)]
address_id (integer) - foreign key (Address id)
<< other UK-specific fields >>

and so on, with one subclass table for each different type of Address.
Method 2: composition
Table 1: AddressFields [validation table, primary key = (id)]
id (integer) - the field
field (string) - which field is this (e.g. "state", "country")?

Table 2: Addresses [data table, primary key = (id, field)]
id (integer) - the address
field (integer) foreign key (AddressFields.id)
value (string) - value of the given field for the given address

Question: in a small database (<1,000 addresses), what would ever cause me to give up the flexibility of the composition version?

redpajama_set_name: RedPajamaStackExchange


Before going on to a hunt, you have to drink and eat. You can now do the same like in Monster Hunter but now you have your very own Monster Hunter Tankard to do so. Alright!
From monster hunter, Rathalos, as a stylized pop vinyl from Funko! figure stands 3 3/4 inches and comes in a window display box. You can choose between the normal version and the limited edition. A cool gift for Monster Hunter fans.
New from Capcom Creator's Model Series comes the iconic monster, Rathalos! Approximately 8.25″ tall, 11″ wide, and 9.4″ deep. This officially licensed statue is the perfect centerpiece to a Monster Hunter fan's collection!
This is the perfect gift for Monster Hunter fans. This box set contains 6 monsters which could contain: Valphalk, Massacre Demon Diablos, Silver Ridge Gammoth, Heavenly Eye Mizutsune, Lao-Shan Lung, Massacre Demon Diablos (Raging), Bonus: Valphalk (Clear Version).
Monster Hunter World just won RPG of the year and we absolutely agree. We're completely addicted to it. If you're a fan like us, you wouldn't want to miss out on this very cool Nergigante statue.
This is a nicely 3d printed Monster Hunter Anvil inspired hammer. It is printed in PLA plastic in 5 simple pieces; the fully assembled hammer measures a length of 27 inches.
The secret to slay big monsters is having a big sword. So you can't go wrong with this Monster Hunter Carbite Sword.
If you're planning to take on some real monsters in your neighbourhood, you will need the right gear. This Odogaron suit from Monster Hunter World will set you on your way.


Did you know you can easily add more value to the sale of your home? And it is really not as hard as some people think. Let our Agents at Hill & Viteri Property help you to achieve the best price for your property and show you what to do to sell your home. Give us a call now on 02 9545-2220 or fill out our contact form here and one of our professional real estate agents will be able to assist you.
Q: How can I easily add more value to my home?
A: Adding value to your home could be as simple as giving it a good clean, and fresh paint.
Depending on the condition you might need to make some renovations.
Q: Are there other ways to add value to my home?
through creative marketing and smart negotiation, in order to obtain a higher sales price.
Q: How Should I prepare my home for sale?
A: Declutter your home and make sure you give it a good clean.
Removing any pets would be a good idea too.
and how to have it prepared for presentation.
At Hill & Viteri Property our agents know all the variables that can affect your property either positively or negatively.
can help us to achieve a better price for the sale of your home.
Our agents understand the art of marketing and how to add more perceived value to your home.
Through smart creative's and articulate narratives, we attract the right buyers to your property.
Q: Is cleaning and decluttering my home essential to the marketing of my property?
A: Absolutely, you want to make sure your home is well presented to your potential buyers.
A good agent will give you the right presentation tips depending on your situation.
For each home seller, it is a different situation for each home on the property market.
is a vital ingredient when you are trying to achieve the best price for your property.
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As a first-year, adjusting to your new environment can be challenging, but these early months are also exciting as they bring opportunities to make new friends and experience new things. The College provides lots of ways to meet people and find your niche. Your Lafayette email will quickly be filled with messages informing you of these events, and you can also look online at the Lafayette calendar of events.
This year's Involvement Fair and Fete is on Sept. 6. You'll find each campus club represented in the huge maze of tables set up on the Quad. See a club that you like? Sign up to join the group and its email list on the spot. Don't be afraid to explore—I signed up for 10 to 15 clubs at the fair and ultimately joined about five. This event is a great way for you to make connections with people who share your interests.
Lafayette offers many sporting events that you can attend in the fall like soccer, football, cross country, volleyball, and field hockey. Football and volleyball are especially easy to watch since the games are played on campus. The Homecoming and Lafayette-Lehigh Rivalry games are particularly fun! All sporting events are free for students, and they're a good way to meet people and cheer on your fellow Leopards.
You can get your exercise by walking down and back from the farmers' market held downtown most weekends in the fall. Local farmers and businesses set up tents selling just about any kind of food you could want. On the way to the farmers' market you will pass Sweet Girlz Bakery—their delicious cupcakes are not to be missed if you have a sweet tooth. The farmers' market is one of many ways to engage with the Easton community.
Pard Glow is a fun-filled night in September that includes a DJ and glow-in-the-dark paint sprayed into the crowd. Don't forget to pick up your free T-shirt in Farinon the day of the event.
This dance marks the fact that you have 1000 nights left before you graduate from Lafayette. The semi-formal event is for first-year students only, and includes dancing, free food, and a photo booth. Last year there was even an indoor roller skating rink! This evening is a great way to meet other first-year students. When you are a senior and have 100 nights left until graduation, there will be another dance celebrating your time at Lafayette.
Floor programs are a way to get to know—you guessed it—more people on your floor. Your RA (resident advisor) will choose an event for your floor to enjoy together. Fun floor programs I attended last year included cookie decorating, a concert that my floormates performed in, a yoga class, a political debate, eating pizza, and many others. These events will be held throughout the year and can be helpful to attend as your RA may also use them to communicate important information.
Work it out to stay in shape and make new friends at the same time. Attend a cycling class, Zumba, or even Zen out at yoga. These classes are all free, though you have to sign up ahead of time as they often have a limit and fill up quickly.
There are lots of ways to become an involved member of the Lafayette community. Take advantage, do at least a few things outside your comfort zone, and your adjustment to college life will feel seamless. See you on campus—and enjoy your first year!
When are this years Pard Glow, 1000 nights and floor programs?
Hi Debbie – We would suggest reaching out to Campus Life (610.330.5082) for specifics about this year's Pard Glow and 1000 Nights since they aren't on the campus calendar yet. As for floor programs, individual RAs coordinate those dates with their residents.
What is the date this year for "Parents Weekend"?
Hi, Mary Jo. Family Weekend is Sept. 23-25 this year. For more info, visit https://families.lafayette.edu.


text:
Incidence and predictors of surgical site infection after ORIF in calcaneus fractures, a retrospective cohort study
Hui Wang1,
Honglei Pei1Email author,
Meiyun Chen2 and
He Wang3
Journal of Orthopaedic Surgery and Research201813:293
Received: 5 September 2018
Accepted: 12 November 2018
Occurrence of calcaneus fractures is on the up trend. Owing to its unique anatomical morphology and limited soft-tissue envelope, management of calcaneus fractures is a challenge to the orthopaedic surgeon, and surgical site infection (SSI) is one of the serious postoperative complications. In order to decrease the incidence of wound breakdown and improve clinical outcomes, it is necessary to understand which factors were associated with SSI. The aim of this study was to identify predictors of SSI and quantify the incidence of SSI in calcaneus fractures following open reduction and internal fixation (ORIF).
This retrospective study was performed at a level 1 trauma center from January 2014 to June in 2017. Data of adult patients with calcaneus fractures treated by ORIF were extracted from the electronic medical records. A total of 681 patients were collected. We reviewed the patients' demographics, characteristics of fracture, treatment-related variables, and indexes of laboratory examination. Univariate and multivariate logistic analysis models were performed respectively to determine independent predictors of SSI.
Sixty-six patients developed SSI in this study. The overall incidence of SSI after ORIF of calcaneus fracture was 9.7%, with 2.9% for deep infection and 6.8% for superficial SSI. Independent predictors of SSI identified by multivariate analysis were open fracture (odds ratio = 9.48, 95% CI = 4.53–19.85, P = 0.00007), high-energy injury (odds ratio = 2.07, 95% CI = 1.16–3.70, P = 0.01437), ASA class 3 or higher (odds ratio = 3.50, 95% CI = 1.18–10.37, P = 0.02401), and intraoperative temperature < 36.0 °C (odds ratio = 1.69, 95% CI = 1.13–2.28, P = 0.04410).
The SSI incidence was high (9.7%) for calcaneus fractures following ORIF. External fixation plays an important role in the treatment of severely displaced and depressed intra-articular or open calcaneus fractures. Increased ASA class and intraoperative hypothermia were associated with wound breakdown, and elaborative evaluation of fracture and soft-tissue damage was vitally necessary in this at-risk population.
Calcaneus fractures are commonly seen injuries in the fracture of foot. Previous studies have stated that calcaneus factures accounted for 1 to 4% of all adult fractures [1, 2], and 60–80% are displaced intra-articular calcaneus fractures (DIACFs) [1–4]. Calcaneus fractures especially DIACFs were mainly caused by an axial loading mechanism, which is directed through the somewhat laterally situated calcaneal tuberosity. Current data of clinical epidemiology of orthopedic trauma demonstrated proportion of traumatic fractures caused by traffic accident, fall from heights, and crushing injury were 20.4, 9.2, and 9.7%, respectively [5]. Approximately 30% of such fractures occur in manual laborers, and 20% are work related. In recent years, the optimal management of displaced intra-articular calcaneus fractures is controversial [6]. Open reduction and internal fixation is the optimum treatment strategies for severely displaced or depressed intra-articular and the open calcaneus fractures. The surgical treatment for calcaneus fractures aims to restore the heel height and length, realign the posterior facet of the subtalar joint, and restore mechanical axis of the hindfoot [7]. However, complications following surgical treatment are inevitable and surgical site infection (SSI) is a serious one. The prevalence of wound infection in closed calcaneus fractures varies from 2 to 25% [8–10]. Incidence of deep tissue infection following open calcaneus fractures has been reported up to 10–39%, and eventual amputation to 8.0–14% [11–13]. Debridement or implant removal and even amputation is needed to control severe wound infection, which will greatly affect these patients' quality of life. Furthermore, readmission to hospital will substantially increases healthcare costs for patients and society. How to prevent the infection of surgical sites has become a major challenge for orthopedic surgeons.
Risk factors of postoperative wound infection following open reduction and internal fixation (ORIF) of calcaneus fractures have been identified by some previous studies, including male sex, a history of active smoking, diabetes mellitus, higher body mass index (BMI ≥ 30 kg/m2), drug abuse, open fracture, Sander type, delaying definitive fixation more than 14 days, operation time of more than 2 h, tourniquet time of more than 1.5 h, estimated blood loss, single-layered closure, surgeon experience, hospital stay, and high number of persons present in the operating room during entire surgical procedure [6, 8, 14–17]. However, most of these investigations possess the inherent features of data aging and small sample size and some literatures even suggest the opposite. We wished to ascertain whether there were relationship between these variables and wound infection by this large-simple study.
Given that, we designed this retrospective study to address this tissue. The purposes of this study were to [1] quantify the incidence of postoperative surgical site infection and [2] identify the independent risk factors associated with SSI treated by ORIF of calcaneus fractures.
Our investigation retrospectively identified patients 18 years or older with acute calcaneus fractures treated by ORIF at our hospital during January 2014 to June in 2017, with postoperative follow-up ranged from 12 to 42 months. Patients with complete follow-up data could be included in this study. The exclusion criteria were patients younger than 18 years, implant removal following calcaneus fractures, non-surgical treatment, pathological fractures, and old fractures (> 21 days from initial injury). Therefore, a total of 681 patients were finally included and related data were analyzed.
All data were abstracted from the electronic medical record. Demographic information of patients included gender, age, living places (rural or urban), occupation, height, and weight. BMI was divided into six groups according to the Chinese reference criteria: underweight, < 18.5; normal, 18.5–23.9; overweight, 24–27.9; obesity, 28–31.9; morbid obesity, 32 and more. Tobacco and alcohol consumption, drug addict and comorbidities (coronary heart disease, hypertension, diabetes mellitus, anemia) were also inquired and recorded.
Characteristics of fractures included Sander's classification, injury mechanism, injury type (closed or open), side involved, and coexisting injuries. Injury mechanism was classified as high energy if the fractures caused by traffic accidents or fall from heights and sporting activity (Fig. 1).
The etiology data of injury mechanism of the study group
Other treatment-related variables such as surgeon level (visiting and resident staff), preoperative stay, operation seasons, surgical approach (extended lateral approach, minimally invasive approach, and others), lengths of operative incision, operative time, intraoperative blood loss, intraoperative temperature (30 min before the end of operative procedure), fixation type, oral or intravenous use of antibiotic, and postoperative drainage tube were also extracted. Preoperative stay was defined as the interval between injury occurrence and operation and was divided into two groups: (1) ≤ 14 days and (2) > 14 days. It should be pointed out that we add up all incisions to calculate the exact lengths if there were several operative incisions in one approach. According to our protocol, antibiotics were given within 30 min before surgery as well as supplemental use of antibiotics due to prolonged operative time and obesity of patients after operation was identified as intraoperative use. ASA (American Society of Anesthesiologists) index [18] was used to evaluate patients' physical status and surgical risk.
For preoperative variables of laboratory examination, we reviewed white blood cell (WBC), neutrophile granulocyte (NEUT), lymphocyte (LYM), monocyte (MON), basophilic granulocyte (BAS), serum total protein (TP), albumin (ALB), globulin (GLOB), and albumin/globulin value (A/G). According to their values, we divided these variables into normal (a range), above normal, and below normal.
Regarding to polytrauma, we defined it as injury more than one of the musculoskeletal, abdominal, cardiothoracic, urogenital, vascular, and central nervous systems. In order to quantify patients' coexisting trauma by digits, we used "1" to represent the injury of different sites. For example, if a patient suffered from left calcaneus fracture of Sanders III, accompanied by 23-A3.1 fractures (according to the OTA/OA classification) of distal ulna and radius and traumatic rupture of the spleen, we label him as "2."
SSI was defined based on the standard Center for Disease Control (CDC) definitions. Infections involving deep soft tissue, muscle, or fascia; persistent wound discharge or dehiscence; visible abscess or gangrenosis that requiring surgical debridement and implant exchange or removal were identified deep SSI. We diagnosed the infection as superficial SSI if it met at least one of the following criteria: only shin or subcutaneous at the wound site associated with infection and oral or intravenous antibiotics treatment for incision problems (redness, swelling, pain) but did not meet the criteria of deep SSI regardless of bacterial culture results.
This study was approved by the Institutional Review Board of our hospitals.
A univariate logistic analysis was used to assess the relationship between each categorical variable and SSI. Mann-Whitney U test was used for non-normally distributed continuous variables and t test for normally distributed variables. The significance was set at P < 0.05 (*P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001). Variables tested to be approximately predictive (P < 0.1) of SSI by univariate analysis were entered into a multivariable logistic regression model to determine independent predictors of SSI. Adjusted odds ratios and their respective 95% CIs were reported in the multivariable analysis. The Hosmer–Lemeshow test was used to examine goodness-of-fit of this model, and the significance threshold was set at P > 0.05 indicated an acceptable fitness.
Feature of the study sample
Overall, 725 patients with calcaneus fracture were collected. Six fractures were treated non-surgically; 27 patients were excluded because of closed reduction and percutaneous Kirschner wire fixation; 2 were pathological fractures and 9 patients were under 18 years; therefore, a total of 681 patients were treated by ORIF and included in this study. Of them, 625 were males and 56 were females, with a mean age of 42.4 years (range from 18 to 74) and male-to-female ratio of 11.2:1. Left side of calcaneus fractures were involved in 291 case and right side in 265, and 125 patients suffered from bilateral calcaneal fractures. There were 22 cases of Sanders grade I, 355 cases of Sanders grade II, and 210 and 94 cases of Sanders grade III and IV, respectively. One hundred sixty-two of the patients used tobacco productions. Thirty-five fractures were open, and all patients underwent debridement before ORIF. Of the open fractures, 16 patients developed SSI after surgery. The average time to definitive internal fixation was 5.7 days, with a minimum of 0 day and a maximum of 37 days. Three hundred fifty-seven patients with calcaneus fractures were caused by high-energy trauma. There were 264 falls from height, 78 vehicle collisions, 6 sporting injury, and 9 injured by others. The 681 patients sustained a total of 928 traumatic injuries associated with musculoskeletal, cardiothoracic, and other systems.
Characteristics of SSI
There were 66 cases of SSI after ORIF of calcaneus fractures, with an incidence of 9.7%. Twenty (2.9%) patients experienced postoperative deep SSI, and 46 (6.8%) of the 66 cases developed superficial infection. The earliest diagnosis of SSI occurred at 3 days after operation, and the latest presentation was at 107 days, with a median time of 5 days. Fourteen cases of deep SSI and six superficial SSI of the infected patients' bacterial culture results were extracted from the electronic medical record. Staphylococcus aureus, the most commonly seen pathogen, were cultured in 13 patients' swab of wound secretions. Four were caused by Escherichia coli. Pseudomonas aeruginosa were identified in 1 case following Methicillin-resistant Staphylococcus aureus (MRSA) in 2 cases. Seventeen patients underwent irrigation and debridement to control the infection. Internal implant was removed in 2 cases because of persistent positive culture and apparent clinical signs of infection even after antibiotics treatments.
Demographical and perioperative variables such as age (41.4 versus 42.5 years, P = 0.43910), preoperative stay (5.7 versus 5.7 days, P = 0.97616), lengths of surgical incision (9.2 versus 9.0, P = 0.76514), and operative duration (117.4 versus 106.7 min, P = 0.05639) were presented in Table 1. However, there were no significant differences for these variables mentioned above between patients with and without SSI. The mean intraoperative blood loss was 155.6 ml for patients with a wound infection and 122.2 ml for the non-SSI group (P = 0.01501). The mean final intraoperative temperature was 35.8 °C in the group who developed SSIs compared with 36.3 °C in the group without SSIs (P = 0.03728). Surgical wound infection prolonged a mean of 14.7 days of hospitalization than that of non-SSI (31.0 versus 16.3 days, P = 0.00701), (Table 1).
Continuous variables tested in patients with and without SSI
Patients with SSI (mean, median, range) (n = 66)
Patients without SSI (mean, median, range) (n = 615)
41.4, 39 (18–66)
Hospital stay (days)
31.0, 21.5 (7–263)
16.3, 15 (4–76)
0.00701**
Preoperative stay (days)
5.7, 5 (0–27)
Operation duration (min)
117.4, 120 (35–250)
106.7, 95 (30–335)
Intraoperative blood loss (ml)
155.6, 100 (10–1000)
0.01501*
Lengths of incision (cm)
9.2, 8.5 (0.5–20)
9.0, 10 (0.5–27)
Intraoperative temperature (°C)
35.8, 36.2 (34.8–36.9)
Significant Variables (*P < 0.05; **P < 0.01; ****P < 0.0001)
Risk factors of SSI
Factors that increased the risk of SSI in univariate analysis are summarized in Table 2. These predictors included injury mechanism (high-energy injury), open fractures, preoperative use of antibiotics, ASA score ≥ 3, operative duration, intraoperative temperature < 36 °C, coronary heart disease, and preoperative basophilic granulocyte (BAS) count. Other variables of demographical characteristics, underlying diseases, biochemical tests, and perioperative factors were not associated with the incidence of SSI (Table 2). All these approximately predictive variables were entered into the multivariate logistic regression model to determine the significant ones. After adjustment for confounding factors, injury mechanism (high-energy injury) (P = 0.01437), open fracture (P = 0.00007), ASA ≥ 3 (P = 0.02401), and intraoperative temperature < 36.0 °C, (P = 0.04410) remained statistically significant for the occurrence of SSI, with the adjusted odds ratio was 2.07 (1.16–3.70), 9.48 (4.53–19.85), 3.50 (1.18–10.37), and 1.69 (1.13–2.28), respectively. However, coronary heart disease, operative duration, basophilic granulocyte (BAS) count, and preoperative use of antibiotics were eliminated from the multivariate analysis as independent risk factors of SSI (Table 3). The value of Hosmer–Lemeshow test demonstrated the preferable fitness (X2 = 3.303, P = 0.347).
Univariate analysis of risk factors associated with SSI
SSI (n = 66, 9.7%)
No SSI (n = 615, 90.3%)
Open fracture
0.00003****
Sanders grade
Operation season (summer)
Intraoperative blood loss (≥ 400 ml)
Extended lateral approach
Fixation type (plate and screws)
Length of operative incision (cm)
< 7
Operative time
< 120 min
120–180 min
> 180 min
Intraoperative temperature(< 36.0 °C)
Preoperative stay
≤ 14 days
> 14 days
Surgeon level (resident and visiting staff)
Injury mechanism (high energy)
Obesity (BMI ≥ 28.0)
History of anemia
Tobacco consumption
History of alcohol intake
Allergic history
Previous operation
ASA score (≥ 3)
Preoperative antibiotics use
Intraoperative antibiotics use
Drainage use
TP (< 65 g/L)
ALB (< 40 g/L)
GLOB (< 20 g/L)
References (1.2–2.4)
< 1.2
> 2.4
WBC (109/L)
References (4–10)
NEUT (109/L)
LYM (109/L)
MON (109/L)
BAS (109/L)
References (0–0.06)
> 0.06
TP total protein, A albumin, G globulin, A/G albumin/globulin, WBC white blood cell, NEUT neutrophile, LYM lymphocyte, MON monocyte, BAS basophilic
Significant Variables (*P < 0.05; **P < 0.01; ****P < 0.0001)
Variables tested for multivariate analysis
95% CI
High-energy injury
ASA ≥ 3
Operative duration
Intraoperative temperature < 36.0 °C
CI Confidential interval
Significant Variables (*P < 0.05; ****P < 0.0001)
With the rapid development of construction and transportation industries, calcaneus fractures actually saw an uptick in its occurrence [1, 2]. Management of calcaneus fractures is a challenge to the trauma surgeon on account of its unique anatomical morphology and limited soft-tissue envelope. However, the benefits of operative treatment may be offset by the subsequent complications. Wound infection, one of the most serious complications, can lead to implant removal, nonunion, and even amputation. From an economic perspective, SSI account for 17% of nosocomial infections, and cost between 1 and 10 billion US dollars annually [19]. All of these endpoint events will inevitably affect the quality of patients' life. In order to decrease the incidence of wound breakdown and improve clinical outcomes, it is necessary to understand which factors were associated with these complications. In this study, the overall SSI rate was 9.7% with 2.9% for deep infection and 6.8% for superficial infection. SSI prolonged the hospital stays up to 14.8 days. Open fractures, high-energy injury, and ASA score ≥ 3 were identified as independent predictors of the occurrence of SSI.
The overall prevalence of SSI in our study was 9.7%, which was conformed to previously reported data [16, 20] and lower than Folk JW's and Liang Ding's retrospective studies [14, 21]. Incidence of SSI after open calcaneus fractures in this study was 45.7% (16/35), which was rather high compared to reported data in previous studies [12, 22]. Specifically, to point out, our hospital was the tertiary referral center and the patients were likely presenting with more severe injuries and more difficult to treat (357 high-energy injury in 681 calcaneus fractures; 681 patients sustained a total of 928 traumatic polytrauma). All these factors together may lead to a higher prevalence of infection in open fracture. Incidence of wound infection in closed calcaneus fracture was 7.7% (50/646) in our study, and this value was in the range of reported data (2–25%) [8–10]. According to the results of this investigation, occurrence rate of superficial and deep infection was 6.8 and 2.9%, respectively. The prevalence of deep infection has been quoted as being between 1.8 and 21% [16, 20]; thus, our infection rate is comparable to those in the literatures. Four hundred fifty-one cases (66.2%, 451/681) of calcaneus fractures were treated by ORIF via minimally invasive approaches (the limited lateral, obtuse-angled, medial, combined medial and lateral, posterior, percutaneous, and sinus tarsi approaches). Although the investigation of this technique is still ongoing and controversial [20, 23, 24], minimally invasive techniques minimize wound-related complications. The high proportion of minimally invasive approaches in our study likely contributes to a lower incidence of superficial wound infection compared to other investigations [6, 25].
Open fracture as a significant risk factor for postoperative SSI after traumatic fractures of calcaneus and other disciplines has been investigated in literatures [11, 22, 26, 27]. There were 5.1% (35/681) open fractures in this study, and patients were 9.48 times as likely to develop an infection after operative treatment (the odds ratio was 10.04, and 9.48 in univariate and multivariate analysis models). Open calcaneus fracture generally was accompanied by contaminative wound, severe soft-tissue damage. In order to preserve a healthy soft-tissue envelope before final fixation, surgeons have traditionally delayed operative treatment for a few days until hematoma eliminated, stress of incision alleviated, and skin wrinkled. However, many controversies surround the benefits of delaying operative fixation of calcaneus fractures. In Nicholas A. Abidi' study [17], they demonstrated delaying operation at an average of 10 days after injury increased the incidence of wound healing approximately 2.6 times when contrasted with 4.8 days. Preoperative stay was not an independent risk factors in this study (P = 0.36943). However, once this interval exceeds 14 days, the incidence of SSI was significantly increased (15.8 versus 9.5%) and the average time between injury occurrence and surgery was 5.6 days (range 0–27 days) in open fracture group. According to our definition of polytrauma, the 35 patients who were diagnosed as open calcaneus fractures sustained a total of 55 traumatic injuries associated with musculoskeletal, cardiothoracic, and other systems. These patients potentially required extra numbers of surgical operations to recuperate their health. Abdo Bachoura and his colleagues [28] identified 1611 adult patients who underwent 1783 surgical procedures for skeletal trauma, and they found multiple surgeries doubling the occurrence of surgical site infection. Our finding highlighted the fact that open fracture, the independent predictor of postoperative SSI, is still an austere challenge to the trauma orthopedic surgeon. Of the 357 high-energy injury, 47 (13.2%) patients suffered from postoperative SSI and 25 cases (7.0%) were open calcaneus fractures. Higher grade fractures usually accompanied by high-energy injury, and this type of fracture had significantly higher wound complication rates than low-grade ones [29].
Open reduction and internal fixation are the optimum strategies for severely displaced and depressed intra-articular or open calcaneus fractures. Although external fixation cannot replace open treatment in calcaneus fractures, it plays an important role in the recovery of the soft tissue. When performed in a stepwise fashion, external fixation can successfully restore normal calcaneal height, length, width, and coronal plane alignment.
It is time-consuming to restore the heel height and length, realign the posterior facet of the subtalar joint, and restore mechanical axis of the hindfoot in higher grade of comminuted calcaneus fractures. Fractures caused by high-energy injury had a longer operation time than lower grade fractures (111.3 min versus 103.9 min) in this study. Univariate analysis demonstrated operative duration as an approximately risk factors of SSI (P = 0.05660); however, these variables were not associated with wound infection in the multivariable logistic regression model. Prolonged operative time increasing the SSI rate was also been found in other surgical disciplines [30, 31]. High-energy fractures seems to have a positive correlation on the increased postoperative wound infection [12]. This may be due to high proportion of open fracture, disruption of the microcirculation in the soft-tissue envelope of the calcaneus, and prolonged operative time.
American Society of Anesthesiologists (ASA) System, proposed by Saklad [18], has been used since the 1940s as a reliable health evaluation system to characterize operative risk and assess physical status of patients. Nineteen (19/681, 0.28%) patients' ASA score were more than or equal to 3 and 26.3% (5/19) of them developed SSI after surgery. In the univariate and multivariable analysis model, ASA class 3 or higher was identified as a predictor of SSI and the odds ratio was 3.52 and 3.50, respectively. Manouk Backeset al [8] retrospectively studied 191 patients who were operatively treated for unilateral calcaneus fractures. They found ASA classification other than 1 (P = 0.001) showed an increased risk of a postoperative wound infection. The average age of patients in Manouk Backes' study was 45 years which was significantly older than that in our investigation (42 years). Patients (ASA class 3 or higher) were 2.87 times as likely to develop an infection after high-energy lower extremity fractures according to Ebrahim Paryavi and his colleagues' report [19]. Our results also support the strong predictive value of the ASA class for infection risk in orthopedic calcaneus fractures.
The World Health Organization published the Guidelines for Safe Surgery and described "maintenance of normothermia during surgery" as 1 of 10 objectives aimed to reduce the incidence of postoperative surgical site infection in 2009 [32]. Agency for Healthcare Research and Quality has established a similar quality metric using a cutoff of 36.0 °C [33]. However, evidence supporting this hypothesis is lacking to our knowledge and many recent studies demonstrated that there are no correlations between hypothermia and SSI in different disciplines. The normal range of the core body temperature is 36.5~37.5 °C, suppression of the body's thermoregulatory function by anesthetic drugs, and exposure of viscera or limbs to cold environments can result in hypothermia. It has been confirmed that hypothesis (lower than 36.0 °C) has many adverse effects on the surgical patients, such as blood coagulopathy, disturbances of immune regulation, arrhythmia, and prolonged recovery time of anesthesia. In the present study, 18.2% of patients had a hypothermia intraoperatively, and 21 of these cases developed SSI. Regardless of how hypothermia was defined, intraoperative temperature dose predicts SSI in calcaneus fracture patients, and careful surveillance of intraoperative hypothermia is of clinical significance and should be considered. There are significant benefits of warming in the prevention of postoperative complications. It is important to warming patients preoperatively and monitor core body temperature intraoperatively, and these measures include the use of warmed fluids, heating blankets, elastic bandage, and so on.
Univariate analysis demonstrated preoperative use of antibiotics, operative duration, coronary heart disease, and preoperative basophilic granulocyte (BAS) count as risk factors of SSI; however, these variables were not associated with increased risk of wound infection in the multivariable logistic regression model. Operative time was a well-identified risk factor of postoperative wound infection; however, the impact of operative duration was dwarfed by other more important risk factors in this study (open fractures, high-energy injury). In our clinical practice, the use of antibiotics before surgery is an indication of open fracture and basophilic granulocyte (BAS) count was related to the situation of injury; therefore, these variables were superseded by more direct factor (open fracture, high-energy injury) in final analysis model. Eleven patients were diagnosed with coronary heart disease with an average age of 50.6 years, and 3 cases developed SSI after surgery. However, the remaining patients (98.4%, 670/681) were much younger than the 11 cases on account of a mean age of 42.2 years. Therefore, we infer that coronary heart disease more likely be identified as a significant risk factor in geratic calcaneus fractures.
There are several limitations in this single-center study. First of all, the retrospective nature of this study inherited an unavoidable selection bias and the quality of the data depended on the accuracy and completeness of electronic medical records, which might be affected more or less. Secondly, patient-specific covariates (smoking and alcohol consumption, drugs addict, medical comorbidities,) mainly relied on the patient's self-report, and some of them might not be willing to inform us of these bad habits and coexisting diseases. Thirdly, we defined a patient who did not return for treatment of an infection after discharge from our trauma center as non-SSI one; therefore, those who truly developed SSI and admitted to anther hospital for diagnosis and treatment could be miss-collected, which might underestimate the overall SSI rate.
We conduct a retrospective study of consecutive patients with calcaneus fractures treated by ORIF. There were 66 cases developed SSI with an incidence of 9.7% (66/681). The prevalence of superficial and deep infection was 6.8 and 2.9%, respectively. Open fracture, high-energy injury, ASA classification higher than 3, and intraoperative hypothermia were identified as predictors of postoperative SSI. It deserve orthopedic surgeons' attention of the significance of external fixation and prevention of hypothermia in the treatment of calcaneus fractures. More skilled surgical techniques and more reasonable management strategies on open fracture should be utilized to reduce the SSI development.
A/G:
Albumin/globulin value
ALB:
BAS:
Basophilic granulocyte
BMI:
CDC:
DIACFs:
Displaced intra-articular calcaneus fractures
GLOB:
Globulin
LYM:
NEUT:
Neutrophile granulocyte
ORIF:
Open reduction and internal fixation
SSI:
TP:
Serum total protein
WBC:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The datasets generated and/or analyzed during the current study are not publicly but are available from the corresponding author on reasonable request.
HLP designed the study. HW searched relevant studies. MYC and HW analyzed and interpreted the data. HW wrote the manuscript and HLP approved the final version of the manuscript.
This study was approved by the Institutional Review Board of First Hospital of Hebei Medical University and received written consent from all the study participants.
Written informed consent was obtained from each patients' parents for the publication of this report and the accompanying images.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Department of Orthopaedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
Department of General practice, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
Basic Medical College, Hebei Medical University, Shijiazhuang, Hebei, 050000, People's Republic of China
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