Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus.
BACKGROUND
Calcaneal fractures can have long-term consequences in terms of pain and disability. Comparative studies have suggested that operative treatment of these fractures may result in better outcomes than nonoperative treatment; however, to our knowledge, the long-term outcomes of operative treatment of calcaneal fractures have not been reported for a large cohort of patients.


METHODS
One hundred and fifty-seven patients with calcaneal fractures were managed at our institution between January 1, 1989, and April 30, 2003. Seventy-three patients who were managed operatively for eighty-one intra-articular calcaneal fractures responded to a functional questionnaire that included the adjusted American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (subjective component only), the Foot Function Index, and the calcaneal fracture scoring system at a median of 12.8 years (range, 5.0 to 18.5 years) after the injury.


RESULTS
In our study population, the mean adjusted American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 65.4 (95% confidence interval, 60.6 to 70.2), the mean Foot Function Index score was 20.5 (95% confidence interval, 16.6 to 24.4), and the mean calcaneal fracture scoring system score was 69.3 (95% confidence interval, 63.6 to 74.9). Patients who had sustained the calcaneal fracture as a result of a motor-vehicle accident rather than a fall reported significantly worse outcomes on two of three scales (p = 0.04 for the adjusted American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, p = 0.05 for the Foot Function Index, and p = 0.35 for the calcaneal fracture scoring system), but this analysis was limited by the exclusion of twenty-four patients because of crush injuries (two) or unavailable documentation of the mechanism of injury (twenty-two).


CONCLUSIONS
The long-term outcomes of operative treatment described in the present report are comparable with the long-term outcomes previously reported among smaller patient cohorts. Additional investigation is required to determine why patients with fractures that resulted from a motor-vehicle accident reported worse outcomes than patients with fractures that resulted from a fall.
Potter
Michael Q
MQ
Department of Orthopaedic Surgery, Duke University Medical Center, Box 2923, Durham, NC 27710, USA.
Nunley
James A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery*; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult