title: Prognostic value of computed tomography classification systems for intra-articular calcaneus fractures.
abstract: BACKGROUND
  There are several published computed tomography (CT) classification systems for calcaneus fractures, each validated by a different standard. The goal of this study was to measure which system would best predict clinical outcomes as measured by a widely used and validated musculoskeletal health status questionnaire.
  
  
  METHODS
  Forty-nine patients with isolated intra-articular joint depression calcaneus fractures more than 2 years after treatment were identified. All had preoperative CT studies and were treated with open reduction and plate fixation using a lateral extensile approach. Four different blinded reviewers classified injuries according to the CT classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders. Functional outcomes evaluated with a Musculoskeletal Functional Assessment (MFA). The mean follow-up was 4.3 years.
  
  
  RESULTS
  The mean MFA score was 15.7 (SD = 11.6), which is not significantly different from published values for midfoot injuries, hindfoot injuries, or both, 1 year after injury (mean = 22.1, SD = 18.4). The classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders, the number of fragments of the posterior facet, and payer status were not significantly associated with outcome as determined by the MFA. The Sanders classification trended toward significance. Anterior process comminution and surgeon's overall impression of severity were significantly associated with functional outcome.
  
  
  CONCLUSIONS
  The amount of anterior process comminution was an important determinant of functional outcome with increasing anterior process comminution significantly associated with worsened functional outcome (P = .04). In addition, the surgeon's overall impression of severity of injury was predictive of functional outcome (P = .02), as determined by MFA.
  
  
  METHODS
  Level III, comparative series.
authors.affiliation: Mid-Michigan Orthopaedic Institute, East Lansing, MI, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Swords
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA altont@u.washington.edu.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Alton
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Holt
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Sangeorzan
authors.affiliation: Premier Orthopedics, Colorado Springs, CO, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Shank
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Benirschke
mesh_terms: D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000000981:diagnostic imaging* / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000145:classification* / Q000000981:diagnostic imaging*; D018460:Fractures, Comminuted / Q000145:classification / Q000000981:diagnostic imaging; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: calcaneus; classification; computed tomography; fracture; intra-articular; prognostic value