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. 2021 May 28:8:620964.
doi: 10.3389/fsurg.2021.620964. eCollection 2021.

Patient-Reported Outcome Following Operative and Conservative Treatment of Calcaneal Fractures: A Retrospective Analysis of 79 Patients at Short- to Midterm Follow-Up

Patrick Pflüger  1 , Michael Zyskowski  1 , Frederik Greve  1 , Chlodwig Kirchhoff  1 , Peter Biberthaler  1 , Moritz Crönlein  1
Affiliations

Patient-Reported Outcome Following Operative and Conservative Treatment of Calcaneal Fractures: A Retrospective Analysis of 79 Patients at Short- to Midterm Follow-Up

Patrick Pflüger et al. Front Surg. .

Abstract

Background: Fractures of the calcaneus are severe injuries of the hindfoot, mostly resulting from high-energy axial loads, which still present enormous challenges to modern trauma surgery. Possible variables influencing the outcome are the type of fracture, age, and quality of fracture reduction. These might also be factors affecting the self-reported patient outcome, but large studies are still lacking. Therefore, the aim of this study was to analyze the patient-reported outcome of calcaneal fractures following operative and conservative treatment. Methods: All patients suffering from calcaneal fractures between 2002 and 2015 were enrolled in this retrospective analysis. The calcaneal fractures were classified according to Sanders and the AO classification system. For further analysis, two groups were formed: group I involved complex intra-articular fractures defined by the involvement of the posterior calcaneal facet, while group II consisted of extra-articular and process calcaneal fractures. Data were collected via the patient registry, radiographs, and a standardized questionnaire (Foot and Ankle Outcome Score, FAOS). For outcome analysis, non-parametric Mann-Whitney U-test was performed, and Spearman's rank correlation coefficient was calculated. Results: In total, the functional outcome of 79 patients with calcaneal fractures was analyzed. In group 1 (n = 43), the mean FAOS score was 65.5 ± 18.9. The surgically treated patients with a Sanders type II calcaneal fracture had a mean FAOS score of 72.9 ± 17.2, type III fractures had 65.6 ± 20.8, and type IV had 61.1 ± 19 (p = 0.15). The reoperation rate was 22%, most frequently caused by wound complications (10%). The mean follow-up time was 64.5 ± 44 months. The mean FAOS score of group 2 (n = 36) was 75.2 ± 18.4, and 83% of the patients (=30) were managed conservatively. Only one out of six operatively managed patients had a reoperation due to regular implant removal. The mean follow-up time was 31 ± 25.9 months. Conclusion: Intra-articular calcaneal fractures are severe injuries of the hindfoot leading to a fair to poor functional outcome in the majority of the patients. Complications regarding wound healing are the most common causes for revisional surgery. Extra-articular calcaneal fractures are a heterogenous entity commonly managed non-operatively. Overall, they show a better functional outcome in comparison to intra-articular calcaneal fractures.

Keywords: calcaneal fractures; calcaneal injury; calcaneus; hindfoot fractures; patient reported outcome.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer LM declared a shared affiliation, with no collaboration, with the authors PP, MZ, FG, CK, PB, and MC to the handling Editor.

Figures

Figure 1
Figure 1
Flow diagram demonstrating the patients included for the study analysis.
Figure 2
Figure 2
(A) Lateral preoperative radiograph of a Sanders-type 3AC calcaneal fracture. (B) Lateral postoperative radiograph of the calcaneal fracture from (A) with improved plotted Bohler's angle (39°). (C) Lateral postoperative radiograph of a calcaneal fracture with a marked Gissane angle of 123°.
Figure 3
Figure 3
Boxplots of foot and ankle outcome score among the different Sanders-type fractures of surgically treated patients. The whiskers show the minimum and maximum.
See this image and copyright information in PMC

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