SLR - February 2011 - Jason D. Neufeld
Reference: Gaskill, T; Schweitzer, K; Nunley, J (2010). Comparison of Surgical Outcomes of Intra-Articular Calcaneal Fractures by Age. J Bone Joint Surg Am, 92:2884-2889.
Scientific Literature Review
Reviewed by: Jason D. Neufeld, DPM, PGY-3
Residency Program: Kaiser Hayward/Fremont Residency Program
Podiatric Relevance:
Historically, internal fixation for displaced intra-articular calcaneal fractures in the geriatric population has been thought to be high-risk and nonoperative treatment has been advocated. Podiatric surgeons routinely treat these devastating injuries in all age groups. These authors used three validated outcome scores to determine whether outcomes in the elderly were comparable to a younger population.
Methods:
One hundred and ninety-one displaced intra-articular calcaneal fractures underwent internal fixation between 1992 and 2007. For each fracture the American Society of Anesthesiologists score, the fracture pattern, and the mechanism of injury was recorded. One hundred and fifty-eight fractures (146 patients) were available for follow-up and were divided into separate groups for comparison. Patients less than fifty years old, which comprised 108 fractures, were placed in Group I. Group II consisted of 50 patients which were fifty years or older.
Results:
Average patient ages were thirty-six for Group I and fifty-eight years for Group II with a mean follow-up time of 8.98 years. The mean calcaneal fracture scoring system score was 66 or Group I and 76 for Group II. The average adjusted AOFAS score was 64 for Group I and 75 for Group II. Additionally the average Foot Function index was 24 for Group I and 15 for Group II. All outcome measures pointed to better outcomes for Group II. Similar complication rates were found between the two groups. Eventual subtalar joint fusion was needed in 15% of fractures in Group I and 8% in Group II.
Conclusions:
Clinical outcomes of older patients were noted to be equivalent or slightly improved to their younger counterparts in this study. Therefore the authors conclude that operative intervention for displaced intra-articular calcaneal fractures in the older population is a reasonable option. They caution that individual treatment plans are critical in patients with low physical demands or who have medical comorbidities that make them better candidates for nonoperative intervention.