Outcomes of Intra-Articular Calcaneal Fractures: Surgical Treatment of 114 Consecutive Cases at A Maximum Care Trauma Center

SLR - February 2022 - Tiffany M. Chin

Reference: Schindler, C., Schirm, A., Zdravkovic, V. et al. Outcomes of Intra-Articular Calcaneal Fractures: Surgical Treatment of 114 Consecutive Cases at A Maximum Care Trauma Center. BMC Musculoskelet Disord 22, 234 (2021). https://doi.org/10.1186/s12891-021-04088-w

Level of Evidence: III

Scientific Literature Review

Reviewed By: Tiffany M. Chin, DPM
Residency Program: Cedars-Sinai Medical Center – Los Angeles, CA

Podiatric Relevance: The most common tarsal bone injury is the calcaneal fracture which is typically caused by falling from a tall height. It is known that intra-articular calcaneal fractures lead to posttraumatic arthritis. Understanding the relationship between fracture severity and operative treatment methods can better determine outcomes and possibly decrease the need for a subsequent subtalar joint fusion.

Methods: This is a Level III retrospective cohort study between 2002 and 2013 of 140 patients who underwent surgery for intra-articular calcaneal fractures. A total of 129 fractures were eligible and 80 of which were available for a clinical and radiological follow-up. Using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, Short Form 36 Health Status Survey (SF-36), complications and subsequent surgeries, outcome measures were evaluated. 

Results: The mean follow-up was 91 months and overall complication rate was 29 percent of which wound healing (11 percent) and infection (5 percent) were the most common. There was a high rate of posttraumatic subtalar arthritis (77 percent) and 18 percent required a subsequent subtalar joint arthrodesis. After primary fusion, there was a 60 percent revision rate. Mean AOFAS hindfoot score was 74. Of note, patients with a decreased Boehler angle postoperatively had a significantly lower AOFAS hindfoot score (p < 0.01).

Conclusions: The results found in this study can better guide operative treatment of calcaneal fractures. Primary subtalar joint fusion should be considered with caution due to the high incidence of revisions.