Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 26;11(19):5660.
doi: 10.3390/jcm11195660.

Predictive Factors of Poor Outcome in Sanders Type III and IV Calcaneal Fractures Treated with an Open Reduction and Internal Fixation with Plate: A Medium-Term Follow-Up

Luigi Cianni  1   2 , Raffaele Vitiello  1   2 , Tommaso Greco  1   2 , Mattia Sirgiovanni  3 , Giulia Ragonesi  1   2 , Giulio Maccauro  1   2 , Carlo Perisano  1
Affiliations

Predictive Factors of Poor Outcome in Sanders Type III and IV Calcaneal Fractures Treated with an Open Reduction and Internal Fixation with Plate: A Medium-Term Follow-Up

Luigi Cianni et al. J Clin Med. .

Abstract

Background: Consensus on the treatment for severely comminuted calcaneus fractures has yet to be found. This study aims to analyze the functional and radiological short- and medium-term outcomes of displaced calcaneus fractures of type III and IV treated with ORIF, and to identify, if present, the early predictors of unfavorable outcomes.

Methods: Thirty-three calcaneal fractures were included, 23 type III and 10 type IV, according to Sanders classification. AOFAS scales for ankle and hindfoot and SF-12 were used. Böhler and Gissane angles were analyzed before and after surgery.

Results: The minimum follow-up was six years. The mean AOFAS score at six months was 16.5 points (24.2 ± 10.8 vs 10.8 ± 9.5; p = 0.03) with better outcomes in patients with Sanders type III fractures. This difference decreased in the subsequent follow-up. Likewise, the mental and physical score of SF-12 had the same trend. Two wound infections and no deep infections were recorded in the Sanders type III fracture group. Instead, in the Sanders type IV group, there were four wound infections and one deep infection.

Conclusions: Clinical and radiological outcomes in Sanders Type III and Type IV calcaneus fractures treated with plate and screws were very similar in long-term follow-up. If ORIF provided better short- to medium-term follow-up in Sanders type III fracture, these benefits have been lost in six years. Polytrauma and psychiatric patients showed significantly lower clinical outcomes in long-term follow-up, appearing as the most reliable negative predictors.

Keywords: ORIF; Sanders III–IV classification; calcaneus fractures; fracture; plate fixation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
AOFAS score between Sanders types III and IV. The AOFAS score at six months follow-up showed better outcomes in patients affected by Sanders type III fractures (p = 0.03). This difference gradually decreases at one-year follow-up with the tendency to inversion between the two groups, but without statistical significance.
Figure 2
Figure 2
Physical SF-12 score between Sanders types III and IV. Similarly, the AOFAS score at six months follow-up showed better outcomes in patients affected by Sanders type III fractures. This difference gradually decreases at one-year follow-up with the tendency to inversion between the two groups, but without statistical significance.
Figure 3
Figure 3
Mental SF-12 score between Sanders types III and IV. Similarly, the AOFAS score at six months follow-up showed better outcomes in patients affected by Sanders type III fractures. This difference gradually decreases at one-year follow-up with the tendency to inversion between the two groups, but without statistical significance.
See this image and copyright information in PMC

References

    1. Mitchell M.J., McKinley J.C., Robinson C.M. The Epidemiology of Calcaneal Fractures. The Foot. 2009;19:197–200. doi: 10.1016/j.foot.2009.05.001. - DOI - PubMed
    1. Razik A., Harris M., Trompeter A. Calcaneal Fractures: Where Are We Now? Strateg. Trauma Limb Reconstr. 2018;13:1–11. doi: 10.1007/s11751-017-0297-3. - DOI - PMC - PubMed
    1. Biz C., Barison E., Ruggieri P., Iacobellis C. Radiographic and Functional Outcomes after Displaced Intra-Articular Calcaneal Fractures: A Comparative Cohort Study among the Traditional Open Technique (ORIF) and Percutaneous Surgical Procedures (PS) J. Orthop. Surg. 2016;11:92. doi: 10.1186/s13018-016-0426-6. - DOI - PMC - PubMed
    1. Sanders R., Fortin P., DiPasquale T., Walling A. Operative Treatment in 120 Displaced Intraarticular Calcaneal Fractures. Results Using a Prognostic Computed Tomography Scan Classification. Clin. Orthop. 1993;290:87–95. doi: 10.1097/00003086-199305000-00012. - DOI - PubMed
    1. Agren P.-H., Wretenberg P., Sayed-Noor A.S. Operative versus Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures: A Prospective, Randomized, Controlled Multicenter Trial. J. Bone Jt. Surg. Am. 2013;95:1351–1357. doi: 10.2106/JBJS.L.00759. - DOI - PubMed

LinkOut - more resources