Return to duty and disability after combat-related hindfoot injury.
OBJECTIVE
To characterize the return-to-duty (RTD) rates and disability outcomes for soldiers who sustained combat-related hindfoot injuries that were treated with either reconstruction or transtibial amputation (TTA).


METHODS
Retrospective cohort series.


METHODS
Tertiary trauma center.


METHODS
All patients treated for combat-related hindfoot injuries between May 2005 and July 2011.


METHODS
TTA or hindfoot reconstruction/ankle fusion.


METHODS
Age, RTD rate, combined disability, and associated disabling conditions.


RESULTS
One hundred twenty-two patients underwent treatment for combat-related hindfoot injuries. Fifty-seven patients were treated with amputation, and 65 patients were treated with hindfoot reconstruction or ankle fusion. The overall RTD rate was 20%. Amputees had a RTD rate of 12%, which was lower than those who had a fusion or hindfoot repair [26% (P < 0.06)]. The disability ratings of amputees were significantly higher than those patients undergoing either ankle fusion or primary hindfoot repair [75% and 62%, respectively (P < 0.006)].


CONCLUSIONS
While RTD rates were higher for hindfoot reconstruction or ankle fusion compared with TTA, psychiatric conditions were more common among these patients. Although there were clear differences between both groups, the relationship between true functional outcomes and disability ratings remains unclear and both treatment groups seem to do poorly in terms of returning to active duty.


METHODS
Therapeutic level III. See instructions for authors for a complete description of levels of evidence.
*Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX; and †Department of Orthopaedic Surgery, Carolinas Medical Center Orthopaedic Surgery, Charlotte, NC.
Andrew J
AJ
Sheean
Chad A
CA
Krueger
Joseph R
JR
Hsu
D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001753:Blast Injuries / Q000453:epidemiology* / Q000601:surgery*; D018409:Foot Injuries / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D015995:Prevalence; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data; D062707:Return to Work / Q000706:statistics & numerical data*; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D013978:Tibial Fractures / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology