Background: The reported incidence of calcaneocuboid joint (CCJ) involvement in calcaneal fractures varies considerably. It is largely unknown to what extend CCJ involvement accounts for outcome in these fractures. Therefore, the goal of this study was to analyse the incidence and effects of CCJ involvement in calcaneal fractures.

Patients and Methods: The clinical records of 106 patients, treated between 2001–2007, were reviewed for fracture classification, injury mechanism, surgical treatment and complications. In a prospective cross-sectional study 44 patients were assessed clinically (SF-36 score, AOFAS) and radiographically. Gait analysis was performed using dynamic pedography.

Results: 68 % of all fractures had involvement of the CCJ. Fractures with CCJ involvement were caused by a more severe injury than fractures without CCJ involvement (Mann-Whitney-Test, p=0.03), this is reflected by a strong association between CCJ involvement and fracture classification (Spearman, p< 0.006). Patients with involvement of the CCJ – especially those with a postoperative step in the CCJ – achieved a lower SF-36 score as well as a lower AOFAS score than patients without CCJ involvement. CCJ involvement was associated with more difficulties in walking on rough surface (Spearman, p = 0,020). Limitations during gait were confirmed by dynamic pedography. Grading of posttraumatic OA was associated with fracture classification. (χ²-test p< 0.02) and quality of reduction (χ²-test p< 0.01).

Conclusions: These results indicate that calcaneal fractures with involvement of the calcaneocuboid joint are associated with more severe trauma and worse outcome. Thus the CCJ should be given more credit during surgery and in our research efforts.

Objective: 1997 Zwipp [1] proposed a 5-point scoring system for the classification of the complex trauma of the foot. However, outcome and quality of life after this injury have not been studied systematically. Therefore, the objective of this prospective cross-sectional study was to evaluate the functional outcome and quality of life after complex trauma of the foot

Patients and Methods: 74 patients with a complex trauma of the foot (≥5 points on the Zwipp-Scale) were treated between 2001 and 2007 in the authors’ institution. 50 patients met the inclusion criteria. Using standardized evaluation forms all relevant parameters concerning patients’ history and clinical data were recorded, including items to calculate the AOFAS-Score, the SF-12 and the VAS-Foot and Ankle Score. All patients were examined by an experienced orthopaedic surgeon and an experienced orthopedist. Finally, functional assessment was competed by dynamic baro-pedography and x-rays.

Results: Primary amputation was necessary in 15 patients, 11 x on the level of the forefoot, 2x in the tarsal region and 1x at the level of the thigh. After initial preservation of the foot 4 secondary amputations were necessary. a compartment syndrome was diagnosed in 30 patients. Soft tissue coverage was achieved 12 x using a free vascular flap, 17 x using split skin grafts und 4 x using full skin grafts. On average 4 operations were necessary. The complication rate was 19%. Mean follow-up was 3.5 [1–5] years. At that time the AOFAS Score was 74 (60–100), the SF-12 Score 42.9 (physical health summary scale) and the VAS-Foot and Ankle Score was 76.4 (±12.3). The results showed a significant correlation the Zwipp-Scale (p=0,001). Pedographic evaluation demonstrated changes in gait (contact time, gait line, peak pressure) in 79% of the patients. These findings correlated with the radiologic changes of the foot. 46% of the patients did not wear their orthopaedic shoes. 31% of the orthopaedic shoes or orthotic appliances were regarded insufficient by the orthopaedic surgeon and the orthopedist.

Conclusion: Quality of life after complex trauma of the foot is better than expected and comparable to complex monotrauma of the foot (e.g. calcaneus or talus). Long-term outcome is dictated by the trauma of the bones and joints and not the soft tissue trauma. Objective measurements like dynamic pedorgraphy show the limitations of the patients. Orthotic supply can be improved in a reasonable number of the patients.