title: Intra-articular calcaneal fractures treated nonoperatively and followed sequentially for 2 decades.
abstract: OBJECTIVE
  To assess the sequential and long-term patient outcome after nonoperative treatment of a displaced intra-articular calcaneal fracture, and to determine if initial results remain stable or deteriorate in the second decade after the injury.
  
  
  METHODS
  Retrospective case series with sequential follow-up at 2 time points a decade apart.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  At the first follow-up in 1990, hind feet were assessed with a computerized tomographic (CT) scan, radiographs, and with a 100 point score, the Iowa calcaneal score (ICS). At the second follow-up in 2000, the ICS was repeated and the patients completed the visual analog scale and the SF-36 questionnaire.
  
  
  RESULTS
  In 1990, 15 of 24 hind feet had good or excellent results on the ICS. Sixteen of 19 patients returned to their preinjury level of employment. Subtalar arthrosis on the CT scan correlated with lower average scores [64 points vs. 82 points (P < 0.035)]. Ten years later in 2000, the average ICS had decreased from 74 points to 64 points (P < 0.03); however, in patients with no or minimal arthrosis detected on the 1990 CT scan, the scores remained stable with an average of 82 points, in 1990, and an average of 81 points in 2000 (P < 0.61).
  
  
  CONCLUSIONS
  These results suggest that after nonoperative treatment of closed displaced intra-articular calcaneus fractures, clinical results correlate with the presence of subtalar arthrosis on CT scans [except for those with grade V (spontaneous fusion)]. Patients with arthrosis grades III and IV have increased pain and deterioration in function in the second decade after injury compared with those with minimal arthrosis (grades I or II) or those who spontaneously fused their subtalar joint. Patients without arthrosis have good outcomes that remained stable over greater than 2 decades of follow-up.
authors.affiliation: University of Iowa Hospitals and Clinics, Iowa City, 52240, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Allmacher
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Galles
authors.forename: J L
authors.initials: JL
authors.lastname: Marsh
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000628:therapy*; D002111:Calcaneus / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors