SLR - March 2011 - Jacob M. Jones
Reference: Gaskill T, Schweitzer K, Nunley J. Comparison of Surgical Outcomes of Intra-Articular Calcaneal Fractures by Age. J Bone Joint Surg Am. 2010; 92:2884-9.
Scientific Literature Review
Reviewed by: Jacob M. Jones, DPM, PGY-2
Residency Program: Southern Arizona VA Healthcare System
Podiatric Relevance:
The decision to take a patient to surgery for internal fixation following intra-articular calcaneal fractures is made after careful consideration of comorbidities, healing potential, and certain social situations. Historical literature suggests that performing open-reduction internal fixation (ORIF) for these fractures in patients older than fifty years of age may be contraindicated due to poor reported outcomes. This study compares outcomes of ORIF of intra-articular calcaneal fractures based on patient age.
Methods: A total of 175 patients with 191 calcaneal fractures who underwent calcaneal ORIF between 1992 and 2007 were retrospectively reviewed. These patients were divided into two groups. Group I (121 patients) consisted of patients younger than fifty years, and Group II (54 patients) was composed of patients greater than age fifty. Chart and radiographic review was completed for each patient, including pre-operative Böhler angle, the American Society of Anesthesiologists (ASA) score, subsequent subtalar fusions, and other complications were recorded. Additionally, a modified scoring system was used via questionnaire using three different scales. Follow-up was achieved in 82% of Group I and 83% of Group II.
Results: In Group I, the most common mechanism of injury was a fall, with a rate of 55%. Motor vehicle accident accounted for 44% of injuries in this group. Comparatively, falls were to blame for 70% of injuries in Group II and motor vehicle accidents accounted for 28%. The mean patient age at time of injury was thirty-six years in Group I and fifty-eight years in Group II. The average adjusted AOFAS-hindfoot score was 64 in Group I compared to 75 in Group II. The mean calcaneal fracture scoring system score was 66 for Group I and 76 for Group II. The average Foot Function Index was 24 and 15 for groups I and II respectively. Pre-operative Böhler angles and ASA scores were similar in both groups. These results suggest better outcomes for Group II compared to Group I.
Conclusions: This study suggests that the use of an arbitrary chronological age limit for definition of a surgical contraindication for performing ORIF in displaced intra-articular calcaneal fractures is not warranted. Patients over the age of 50 with these fractures have at least equivalent outcomes when compared to younger patients, and should not be excluded solely on this criterion. An overall look at the patient’s physiological age and medical history needs to be taken into consideration when weighing treatment options.