SLR - April 2012 - Lee Hlad
Reference: Chechik, O., Rosenthal, R., Salai, M., et. al. (2012) Outcome and Complications of Surgical and Non-Surgical Treatment of Calcaneal Fractures. Journal of Orthopaedics, 8(4),e12.
Scientific Literature Review
Reviewed by: Lee Hlad, DPM
Residency Program: Grant Medical Center, Columbus OH
Podiatric Relevance:
The calcaneus is the most frequently fractured foot bone and accounts for 2 percent of all fractures. All treatments, whether surgical or non-surgical, have complications. Surgical indications include articular step-off of 2mm or greater or marked calcaneal varus/valgus. Surgical outcomes are determined based upon anatomical reduction and can usually yield good results in 60-90 percent of cases.
Methods:
Over a four year period, 47 individuals agreed to participate in an IRB approved study. All patients were interviewed, had a thorough physical examination and a functional evaluation was performed using the AOFAS score. Patients were then treated with either surgical or conservative methods.
Results:
Of the 47 individuals, there were 36 males (37 fractures), and 11 females (12 fractures). Thirty-one individuals underwent surgical intervention and 16 were treated conservatively. Complication rates were significantly higher among the surgical patients compared to non-surgical patients (p<0.5). Of the 16 people treated conservatively 6 percent had a superficial skin infection, whereas 21 (68 percent) of those treated surgically had complications which included severe post traumatic arthritis (n=2), painful plate and screws (n=5), infection and wound breakdown (n=10), sural neuropathy (n=4), pain of peroneal tendons (n=6), DVT with PE (n=1). AOFAS scores were excellent in 14 (30 percent), good in 9 (19 percent), fair in 8 (17 percent), and poor in 16 (34 percent). Linear correlations showed that the diagnosis of complications and qualifications to receive workers compensation correlated with worse outcomes. Twenty three patients (49 percent) returned to previous occupation, five (11 percent) changed employer’s, and 19 (40 percent) were unemployed. Twenty six of the 47 patients filed a workers compensation claim at the time of the study.
Objective measurements of the affected limb showed heels being 3.2mm wider and 5.6mm shorter when compared to the contralateral foot. Ankle motion was noted to be significantly decreased where ankle plantarflexion was 40.01 degrees compared to 45.7 degrees, ankle dorsiflexion 10.4 degrees compared to 14 degrees, subtalar inversion 7.2 degrees compared to 17.8 degrees, and subtalar eversion 3.4 degrees compared to 8.3 degrees
Conclusions:
Calcaneal fractures are a serious injury and are often fraught with persistent pain, decreased range of motion, flattening and widening of the calcaneus. This study demonstrated a 49 percent excellent outcome and a high rate of unemployment after injury. Surgical intervention may improve joint congruency preventing need for arthrodesis, but are associated with high-complication rates.