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. 2021 Mar 1;22(1):234.
doi: 10.1186/s12891-021-04088-w.

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

Christin Schindler  1 , Andreas Schirm  2 , Vilijam Zdravkovic  3 , Primoz Potocnik  3 , Bernhard Jost  3 , Andreas Toepfer  3
Affiliations

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

Christin Schindler et al. BMC Musculoskelet Disord. .

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.

Keywords: Calcaneal fracture; Operative treatment; Outcome; Subtalar fusion.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection flow chart
Fig. 2
Fig. 2
Case 1 Preoperative radiographs. Radiographs left calcaneus lateral (A) and axial (B) view, 62 year old male patient, non-smoker
Fig. 3
Fig. 3
Case 1 Preoperative CT. Coronal (A), sagittal (B) and axial (C) views representing a Sanders IIb fracture type pattern
Fig. 4
Fig. 4
Case 1 Postoperative radiographs. Lateral (A) and axial (B) radiographs after ORIF via an extended lateral approach
Fig. 5
Fig. 5
Case 1 Radiographs at follow-up Weightbearing left foot lateral (A) and calcaneus axial (B) 40 months post-surgery, AOFAS score 95
Fig. 6
Fig. 6
Case 2 Preoperative radiographs. Radiograph right calcaneus lateral, 35 year old female patient, smoker
Fig. 7
Fig. 7
Case 2 Preoperative CT Coronal (A) sagittal (B) and axial (C) views representing a Sanders IV fracture type pattern
Fig. 8
Fig. 8
Case 2 Postoperative radiographs Lateral (A) and axial (B) radiographs after primary subtalar arthrodesis
Fig. 9
Fig. 9
Case 2 Complications. CT scan sagittal (A) and coronal (B) view 6 months after primary subtalar fusion showing a subtalar non-union
Fig. 10
Fig. 10
Case 2 Radiographs at follow-up Weightbearing right foot lateral (A) and calcaneus axial (B) 27 months post-surgery, AOFAS: 53
Fig. 11
Fig. 11
SF-36 normative data compared to all patients with surgically treated calcaneal fractures. PF: Physical functioning. RP: Role physical. BP: Bodily pain. GH: General health. VT: Vitality. SF: Social functioning. RE: Role Emotional. MH: Mental health
Fig. 12
Fig. 12
SF-36 normative data compared to patients with surgically treated calcaneal fractures depending on Sanders classification. PF: Physical functioning. RP: Role physical. BP: Bodily pain. GH: General health. VT: Vitality. SF: Social functioning. RE: Role emotional. MH: Mental health
See this image and copyright information in PMC

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