SLR - April 2011 - Lauren A. Fisher
Reference: Trevor Gaskill, MD, Karl Schweitzer, MD, James Nunley, MD. (2010). Comparison of Surgical Outcomes of Intra-Articular Calcaneal Fractures by Age. The Journal of Bone and Joint Surgery, 92:2884-9.
Scientific Literature Review
Reviewed by: Lauren A. Fisher, DPM
Residency Program: Massachusetts General Hospital, Boston MA
Podiatric Relevance:
This study serves to compare the surgical outcomes of older patients to those of a younger cohort that were treated with internal fixation for repair of intra-articular fractures of the calcaneus.
Methods:
A retrospective search was conducted of hospital records to identify all patients who underwent operative treatment of an intra-articular calcaneal fracture. One hundred and ninety-five (195) operatively treated fractures were identified between January 1992 and January 2007. These patients were divided into two groups: Group 1 consisting of patients younger than fifty (50) years of age and Group 2 consisting of patients fifty (50) years of age and older. There were 121 patients with 131 fractures in Group 1, and 54 patients with 60 fractures in Group 2. All of the surgical procedures were performed at one institution by fellowship trained foot & ankle or trauma surgeons. All of the patients were contacted to complete a follow-up survey from which the clinical outcome scores were calculated. Follow-up was accomplished in 82% of the fractures in Group 1 and 83% in Group 2.
Results:
One hundred and fifty-eight (158) intra-articular calcaneal fractures in 146 patients were followed for a mean of 8.98 years. Thirty-nine (39) participants were studied. The mean age at the time of the injury was 36 for patients in Group 1 and 58 for patients in Group 2. Ninety-nine (99) patients were male and 47 patients were female. A fall was the mechanism of injury in 70% of Group 2 and 55% in Group 1. Motor vehicle accidents were the cause of injury in 44% of group 1 and 28% of Group 2. The outcomes were measured by the AOFAS ankle-hindfoot score, the mean total Foot Function Index, and the mean calcaneal fracture scoring system score. Each scoring system indicated significantly better outcomes for patients in Group 2 than Group 1. The complication rate for Group 1 was 35% and Group 2 was 38%. Later conversion to a subtalar fusion was 15% in Group 1 and 8% in Group 2.
Conclusions:
From this study, operative intervention appears to be a reasonable option for older patients who have suffered intra-articular fractures of the calcaneus. However, a non-operative treatment group was not included for comparison. It is important to consider physiologic age verses chronologic age when evaluating an older patient with this particular injury. Prospective studies are needed to address operative indications and outcomes in older patients who have sustained an intra-articular fracture of the calcaneus.