SLR - January 2018 - Jonathan Shih

Functional Outcome After Calcaneus Fractures: A Comparison Between Polytrauma Patients and Isolated Fractures

Reference: Pablow Renovell-Ferrer, Xavier Berto-Marti, Jose Diranzo-Garcia, Luis Barrera-Puigdorells, Vicente Estrems-Diaz, Antonia Silvestre-Munoz, Antonio Bru-Pomer. Functional Outcome After Calcaneus Fractures: A Comparison Between Polytrauma Patients and Isolated Fractures. Injury. 2017 Nov; Vol 48(6):S91–95.

Scientific Literature Review

Reviewed By: Jonathan Shih, DPM
Residency Program: Wheaton Franciscan Healthcare, St. Joseph Hospital, Milwaukee, WI

Podiatric Relevance: Calcaneal fractures are commonly treated by foot and ankle surgeons. Of importance, the consequences of displaced intra-articular fractures of the calcaneus have long-term consequences that are disabling for patients. Of these displaced intra-articular calcaneal fractures, many calcaneal fractures present as polytrauma. Most common injuries involve spinal fractures, contralateral calcaneal fractures and other various extremity injuries. Patients with polytrauma functional are worse than isolated injuries according to literature. There has not been anything published, according to this article, comparing surgical and functional outcomes comparing isolated versus polytrauma displaced intra-articular calcaneal fractures.

Methods: A retrospective review of 80 patients with displaced intra-articular calcaneal fractures who were treated with open reduction and internal fixation from January 1, 2007 to December 31, 2015. Twenty-one patients had bilateral calcaneal fractures, of which only twelve were surgically repaired. Inclusion criteria included intra-articular calcaneal fracture Sanders type II to IV, ages 16 to 70, and open reduction internal fixation through standard lateral extensile approach with plating. Exclusion criteria included extra-articular calcaneal fractures, different surgical techniques, primary arthrodesis and conservative treatments. No comorbidities were excluded. Further, the authors then classified the severity of impact into four categories: fall from same height, fall from less than 3 meters, fall from height greater than 3 meters and direct crush injuries (MVA). Polytrauma was determined utilizing the injury severity scoring (ISS) system. Concomitant injuries included bilateral calcaneal fractures, pelvis fractures, spine fractures and extremity fractures. Comorbid conditions that included psychiatric patients, opioid addiction or alcoholism showed a common correlation with injuries associated with jumping from a height. Functional outcomes were evaluated with AOFAS and SF-36 forms. The AOFAS scores were divided into four categories: 90–100 excellent, 80–89 good, 70–79 fair and less than 70 poor.

Results: There was a significant statistical relationship between polytrauma patients and psychiatric comorbidities, severe trauma or severe injury. There was no significance in this group with second surgeries, future subtalar fusion or outcomes. Calcaneal fractures that were comminuted according to Sanders classification were associated with future secondary surgeries and subtalar arthrodesis. As to functional outcomes, the trauma severity was directly associated with the AOFAS and SF-36 form. This study saw that patients with worse injuries had lower functional outcome scores.

Conclusion: This study did not show any significance with outcome functional measures and secondary surgeries between polytrauma patients and isolated fractures. In this study, they observed that the severity of impact with displaced intra-articular calcaneal fractures were associated with more secondary surgeries and worse functional outcome scores. Patients who had displaced intra-articular calcaneal fractures with psychiatric comorbidities presented with worse health-related quality of life than people without this background.  

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