Outcomes of intra-articular calcaneal fractures: surgical treatment of 114 consecutive cases at a maximum care trauma center

Abstract

Background The aim of this retrospective monocentric study was to investigate the outcomes of surgically treated intra-articular calcaneus fractures in a maximum care trauma center. Methods One hundred forty patients who had undergone surgery for intra-articular calcaneal fractures between 2002 and 2013 were included. One hundred fourteen cases with 129 fractures were eligible to participate in the study of which 80 were available for a clinical and radiological follow-up. 34 patients were followed up by telephone interview only. Outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, Short Form 36 Health Status Survey (SF-36), complications, and subsequent surgeries. Results Mean follow-up was 91 months (range 12–183). The overall complication rate was 29% (37/129 ft). Disturbed wound healing (11%) and infection (5%) occurred most commonly. Non-union (4%) only occurred in smokers (p = 0.02). A high rate of posttraumatic subtalar arthritis (77%) and need for subsequent subtalar fusion (18%) without independent risk factors for subsequent subtalar fusion was found. The revision rate was high (60%) after primary fusion. Mean AOFAS-hindfoot score was 74 (Sanders I: 99, Sanders II: 74, Sanders III: 77, Sanders IV: 70). The postoperative Boehler angle improved significantly in all subgroups (p < 0.01). Patients with a decreased Boehler angle between postoperative images and the follow-up had significantly lower AOFAS hindfoot scores (p < 0.01). Conclusions Our data can aid decision-making in the treatment of calcaneal fractures. We advocate to use primary subtalar fusion with caution due to the high revision rate. Smoking status should always be considered. Level of evidence: Level III, retrospective cohort study.

Evaluation of Bohler Angle, SF-36, and VAS Score in Operative vs Nonoperative Treatment of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis

“…Finally, the patient's preference should be taken into account, and if they are hesitant about surgery or prefer non-operative treatment, this should be respected and discussed with their physician. [19]…”

Radiographic and functional outcome of operated closed intra-articular fractures of calcaneum: a retrospective analysis

“…Apart from the usual complications of any fracture fixation calcaneum is notorious for high incidence of skin complications and sab talar arthritis. 11 Studies have revealed a 70-100% incidence of subtalar arthritis in the long term follow up. [9][10][11] Some authors resort to subtalar fusion due to counter this dreaded complication.…”

“…11 Studies have revealed a 70-100% incidence of subtalar arthritis in the long term follow up. [9][10][11] Some authors resort to subtalar fusion due to counter this dreaded complication. 12 Our study concluded no significant difference between the two techniques.…”

Eklem İçi Kalkaneus Kırıklarında Sinus Tarsi ve Ekstensil Lateral Yaklaşımın Karşılaştırılması

“…Problems related to the subtalar joint have been reported, especially in publications on the EL approach (24). In a large-series study with a mean follow-up of 91 months, the rate of subtalar arthritis was found to be 77%, and it was reported that fusion was required in 18% of them (25). In the EL approach, it is necessary to wait for the foot edema to regress and skin lines to appear to avoid complications related to the surgical area.…”