FUNCTIONAL OUTCOME FOLLOWING OPERATIVE FIXATION OF INTRA-ARTICULAR CALACNEAL FRACTURES

Abstract

Introduction

Considerable controversy exists with regard to the surgical management of displaced intra-articular calcaneal fractures. Protagonists for internal fixation would suggest there is sufficient evidence to expect better functional outcomes with surgery. However, this is not conclusive.

Aim

To identify factors which improved outcome following surgery.

Method

Between 1994–2000, 28 patients with 30 displaced intra-articular fractures of the calcaneum were treated with open reduction and internal fixation at our hospital (mean age 45 years). We reviewed 20 patients within the Shropshire region using four recognised hindfoot scoring systems. Patients were classified according to Sanders’ classification with pre-operative CT scans. The mechanism of injury and post-operative management were recorded. Clinical and radiographic assessments were also made.

Results

Average follow-up was 3.6 years. The overall surgical results were comparable with similar studies based upon the Maryland Foot Score (30% excellent, 35% good, 30% fair, 5% poor). Seventy-five percent of our patients returned to work within six months at an average of five months. Three patients developed a superficial wound infection. Age, energy of injury, time to surgery, time spent in plaster and time to commencing physiotherapy had no significant bearing on functional outcome. However, early weightbearing at six weeks positively influenced outcome with all four scoring systems (p=0.01, 0.01, 0.02, 0.05) with a deterioration of outcome with delayed weightbearing. This was shown to be due to loss of subtalar joint mobility (r=−0.74, p=0.001).

Conclusions

We propose that good results can be obtained from internal fixation of intra-articular calcaneal fractures with a high probability of early return to work. We recommend that patients be encouraged to weightbear at 6 weeks to optimise mobility at the subtalar joint.