title: Complications following the extended lateral approach for calcaneal fractures do not influence mid- to long-term outcome.
abstract: OBJECTIVE
  Open reduction and internal fixation (ORIF) of intra-articular calcaneal fractures through an extended lateral approach is frequently accompanied by a high complication rate. However, ORIF currently provides the best long-term clinical results. The aim of this study was twofold: (1) to evaluate both mid- to long-term clinical and radiological results of a consecutive series treated by ORIF and (2) to determine the influence of short-term complications on long-term clinical outcome.
  
  
  METHODS
  Patients with a displaced intra-articular calcaneal fracture, treated with ORIF, through an extended lateral approach, in a level-2 trauma centre between 1995 and 2008 were evaluated for the study. The long-term functional outcome (American Orthopaedic Foot & Ankle Society (AOFAS), 36-Item Short-Form Health Survey (SF-36) and Visual Analogue Scale (VAS)) and radiographic results (e.g., Böhler and Gissane angle, height, width and joint reduction) were determined. Short- and long-term complications were documented.
  
  
  RESULTS
  A total of 57 patients matched the inclusion criteria, from which 39 patients agreed to participate in this study (68%). The median follow-up was 6.5 years (range 2-16 years). Based on the AOFAS hindfoot score, 74% of the patients had a good-to-excellent long-term clinical result. Radiological results were satisfying with a median postoperative Böhler angle of 26° and 25° at follow-up. Complications occurred in 32% of all patients; mainly wound-healing problems were noted. Short-term complications did not influence mid- to long-term clinical results (p>0.05). Anatomic reconstruction of the calcaneus was associated with improved long-term clinical results (p<0.05).
  
  
  CONCLUSIONS
  Despite the high complication rate following ORIF of a calcaneal fracture, complications do not affect mid- to long-term clinical outcome. Surgical treatment should focus on restoring the anatomy.
  
  
  METHODS
  Therapeutic level IV.
authors.affiliation: Department of Surgery, Deventer Hospital, Deventer, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: De Groot
authors.forename: A J
authors.initials: AJ
authors.lastname: Frima
authors.forename: T
authors.initials: T
authors.lastname: Schepers
authors.forename: W H
authors.initials: WH
authors.lastname: Roerdink
mesh_terms: D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D057072:Intra-Articular Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D064232:Visual Analog Scale; D016474:Weight-Bearing
keywords: Calcaneal; Calcaneus; Intra-articular fracture; Open reduction internal fixation; Os calcis