title: Severity of injury predicts subsequent function in surgically treated displaced intraarticular calcaneal fractures.
abstract: BACKGROUND
  The treatment of displaced, intraarticular calcaneal fractures (DIACFs) remains challenging and the best treatment choices remain controversial. The majority of patients will have some lasting functional restrictions. However, it is unclear which patient- or surgeon-related factors predict long-term function.
  
  
  OBJECTIVE
  We determined (1) the impact of patient- and surgeon-related factors on function of patients after internal fixation of DIACFs and (2) whether severity of injury correlated with subsequent function.
  
  
  METHODS
  We retrospectively reviewed all 210 patients operatively treated for 242 DIACFs between 2000 and 2003; of these, 127 patients (60%) with 149 fractures were available for followup at a minimum of 69 months (average, 95 months; range, 69-122 months). Severity of injury was quantified by the classifications of Sanders and Zwipp Function was quantified using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, an adjusted Zwipp score, the Foot Function Index (FFI), and the SF-36 physical and mental component summary (PCS and MCS) scores.
  
  
  RESULTS
  At latest followup, the median AOFAS score was 77, the median Zwipp score was 60, the median FFI was 27, and the median SF-36 PCS and MCS scores were 44 and 55, respectively. The foot-related scores and the SF-36 PCS negatively correlated with the severity of injury, work-related injuries, and bilateral fractures.
  
  
  CONCLUSIONS
  We found the severity of a DIACF related to subsequent foot function and quality of life. Both fracture severity classifications predicted function. Anatomic reconstruction of the shape and articular surfaces of the calcaneus leads to predictable function in the medium to long term.
authors.affiliation: Clinic of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Fetscherstr 74, 01307, Dresden, Germany. stefan.rammelt@uniklinikum-dresden.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Rammelt
authors.forename: Hans
authors.initials: H
authors.lastname: Zwipp
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schneiders
authors.forename: Constanze
authors.initials: C
authors.lastname: Dürr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000503:physiopathology / Q000601:surgery*; D050723:Fractures, Bone / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome