Functional outcome following a locked fracture-dislocation of the calcaneus

Abstract

Purpose Locked fracture-dislocations of the calcaneus are uncommon, and a substantial number of these injuries is not recognised or is misdiagnosed at first presentation. The primary aim of this study was to evaluate the long-term outcome in patients with this injury. Methods This is a retrospective cohort study of adult patients who sustained a uni-or bilateral calcaneal fracturedislocation. Outcome was measured using validated questionnaires, including the American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS), Foot Function Index (FFI) and a visual analogue scale (VAS). Results During the 12-year study period a total of 16 patients with 17 locked fracture-dislocations were identified. This represented 6 % of all surgically treated calcaneal fractures (17 of 279). The median follow-up was 48 months. All patients were treated using an extended lateral approach and plate fixation. In one patient with a delayed presentation a primary arthrodesis was performed. The functional outcome scores were available for 14 patients with 14 fractures. The median AOFAS was 74 [interquartile range (IQR) 47-86], the median FFI was 18 (IQR 6-37) and the median VAS for overall satisfaction was 8.2 (IQR 5.5-9.4). A secondary fusion was deemed necessary in three cases. Conclusions This study shows that, with surgical treatment via an extended lateral approach, the outcome in patients with a locked fracture-dislocation of the calcaneus is similar to the outcome of other displaced intra-articular calcaneal fracture types. However, a higher rate of secondary subtalar fusion can be expected.

Surgical treatment of intraarticular fractures of the calcaneus: comparison between flat plate and calcaneal plate

“…Assessing the results using the AOFAS scale, the literature presents rates of excellent results, ranging from 42.22% to 62%. 20 , 21 , 22 In this study, 47.6% of the results were considered good or excellent. It is not possible to state with certainty that the type of fracture may have influenced the score, as in the present sample, the number of tongue-type fractures was small when compared with joint depression.…”

Correlation between the quality of calcaneal fracture reduction and time to return to work

“…Resultados semelhantes foram obtidos no estudo atual em que 23,4% não retornaram ao trabalho, apesar da menor amostra. Cita-se ainda uma desvantagem do tratamento cirúrgico que são as complicações pós-operatórias como infecções, deiscência de sutura, necrose de pele, fenômenos tromboembólicos que têm potencial de necessitar de novas intervenções cirúrgicas, prolongando o internamento e elevando custos (4) .…”

“…Mostram que as fraturas de calcâneo desviadas são tratadas preferencialmente por via cirúrgica, apesar das possíveis complicações quando comparado ao tratamento conservador. Porém, os resultados funcionais de ambos os tratamentos são considerados semelhantes ou o tratamento cirúrgico é discretamente melhor, por isso que não apresentam significância estatística (3)(4)(5)9) .…”

“…Infere-se ainda que, mesmo com estudos com mais de 20 anos de diferença, os resultados são semelhantes (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) . A fratura de calcâneo tem manejo difícil e de pouco progresso apesar de novos tipos de abordagem cirúrgica, como a cirurgia minimamente invasiva.…”

“…O tratamento cirúrgico ganhou mais relevância nos últimos 20 anos, com o objetivo de reduzir anatomicamente as superfícies articulares, permitindo, assim, que o paciente retorne às atividades prévias ao trauma (1,3) . A redução cirúrgica da articulação subtalar permite maior correção das deformidades e um menor tempo para retorno às atividades de trabalho prévias (4)(5) .…”