Abstract
Opinions differ among surgeons whether to operatively fix displaced calcaneal fractures in smokers. In a long term follow-up of operatively treated calcaneal fractures, we considered several factors that could affecting outcomes and complications.
Method: 59 calcaneal fractures in 54 patients that underwent operative fixation for displaced intra-articular fractures from April 1995 to January 2006 were reviewed. There were 18 Tongue type and 41 Joint depression fractures on X-rays. Of 38 available CT scans, 25 were Sanders Type II and 13 were Types III and IV fractures.
Average interval to surgery was 6 days. Postoperative mobilisation regime was passive range of motion immediately following surgery with non weight bearing for 6 weeks. Weight bearing was started at 6–8 weeks. On follow-up, patients were assessed with clinical and radiological exam, completed Short Form-36 (SF-36), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and Visual Analogue Scale (VAS) scores.
Results: The duration of follow-up was between 6 months to 11.2 years (6.4 years). The pre and post operative Bohler angles were 8° ± 11° and 29° ± 6° respectively. There was significant limitation of subtalar movement on the operated side irrespective of the presence of arthritis. The average AOFAS, SF-36 and VAS scores were 79, 58 and 3 respectively. Good results were associated with age < 50 years, ASA grade I, pre-op Bohler angle of < 5° and Sanders < IIC. 89% of patients returned to their previous level of activity after an average of 6.5 months.
Smoking was not associated with early or late complication rates and did not affect outcome.
Conclusions: We think that smoking is not a contraindication for operative fixation of displaced calcaneal fractures.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
