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Severity of Injury Predicts Subsequent Function in Surgically Treated Displaced Intraarticular Calcaneal Fractures

  • Symposium: Tscherne Festschrift
  • Published:
Clinical Orthopaedics and Related Research®

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.

Questions/purposes

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.

Level of Evidence

Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Thomas Zerjatke Dipl.-Biomath from the Institute for Medical Informatics and Biometry at the Medical Faculty Carl Gustav Carus (Dresden, Germany) for his help in performing the statistical analysis and Thomas Albrecht DGPh for the clinical photographs.

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Authors and Affiliations

  1. Clinic of Trauma and Reconstructive Surgery, University Hospital “Carl Gustav Carus”, Fetscherstr 74, 01307, Dresden, Germany

    Stefan Rammelt MD, PhD, Hans Zwipp MD, PhD, Wolfgang Schneiders MD, PhD & Constanze Dürr MD

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  1. Stefan Rammelt MD, PhD
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  2. Hans Zwipp MD, PhD
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  3. Wolfgang Schneiders MD, PhD
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  4. Constanze Dürr MD
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Correspondence to Stefan Rammelt MD, PhD.

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Rammelt, S., Zwipp, H., Schneiders, W. et al. Severity of Injury Predicts Subsequent Function in Surgically Treated Displaced Intraarticular Calcaneal Fractures. Clin Orthop Relat Res 471, 2885–2898 (2013). https://doi.org/10.1007/s11999-013-3062-z

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