title: Analysis of foot and ankle kinematics after operative reduction of high-grade intra-articular fractures of the calcaneus.
abstract: BACKGROUND
  High-grade calcaneal fractures represent a complex injury, with limited data to support the advisability of open reduction. Restoration of foot and ankle kinematics during walking, which has been previously shown to be significantly limited after nonoperative treatment, has never been studied after the operation. This study was designed to address this lack of information to assess the advisability of the operation in this respect.
  
  
  METHODS
  Twenty patients with a minimum of 2 years after Open Reduction Internal Fixation (ORIF) for high-grade fractures were evaluated with a computerized gait analysis system, in addition to the radiographic assessment and functional questionnaires. Foot and ankle kinematic variables in the operated limbs were compared with contralateral limbs and with matched healthy control individuals.
  
  
  RESULTS
  The kinematical gait analysis demonstrated recreation of normal ankle motions in operated patients. Subtalar motion demonstrated relative symmetry between operated and contralateral limbs, but it was still significantly limited compared with healthy controls. Bohler angle was between 15° and 35°. Functional questionnaires and rate of postoperative complications supported the generalizability of our operated group compared with previous literature assessing similar injuries.
  
  
  CONCLUSIONS
  In high-grade calcaneal fractures, when recreation of gross calcaneal anatomy is obtained during the operation, walking ankle motion is recreated as well. However, subtalar motions, although recreated to a certain extent, still demonstrate limitations when compared with noninjured individuals. These results support the advisability of the operation in these complex injuries, but they demonstrate that subtalar motion is not completely normalized despite a favorable anatomic outcome.
authors.affiliation: Orthopedic Department, Meir General Hospital, Sapir Medical Center, Kfar Saba, Israel. iftachhetsroni@gmail.com
authors.forename: Iftach
authors.initials: I
authors.lastname: Hetsroni
authors.forename: Meir
authors.initials: M
authors.lastname: Nyska
authors.forename: David
authors.initials: D
authors.lastname: Ben-Sira
authors.forename: Yoav
authors.initials: Y
authors.lastname: Arnson
authors.forename: Chen
authors.initials: C
authors.lastname: Buksbaum
authors.forename: Elchan
authors.initials: E
authors.lastname: Aliev
authors.forename: Gideon
authors.initials: G
authors.lastname: Mann
authors.forename: Sabri
authors.initials: S
authors.lastname: Massarwe
authors.forename: Gal
authors.initials: G
authors.lastname: Rozenfeld
authors.forename: Moshe
authors.initials: M
authors.lastname: Ayalon
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology* / Q000601:surgery; D001696:Biomechanical Phenomena; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult