Session VII - Foot and Ankle

Intraarticular Calcaneal Fractures Observed Sequentially for Two Decades

David Allmacher, MD; Kyle Galles, MD; J. Lawrence Marsh, MD; University of Iowa Hospital, Iowa City, Iowa, USA

Purpose: It is unknown whether the short-term and intermediate results after displaced intraarticular calcaneal fractures are predictive of long-term outcome. We sequentially evaluated patients with nonoperatively treated fractures at an average of 12.8 years and 22 years to address this question.

Materials and Methods: Between 1970 and 1985, closed calcaneal fractures at our institution were treated nonoperatively. Twenty-four fractures (19 patients) were initially evaluated at an average of 12.8 years' follow-up (5 to 20 years) with a questionnaire, clinical examination, and imaging studies. Twenty fractures (16 patients) were restudied at an average of 22 years (15 to 30 years) after injury. The same outcome instrument was used, and, in addition, the patients were asked to evaluate their health with use of a visual analog scale and the SF-36 health survey.

Results: At the initial evaluation, 63% of patients had an excellent or good result and 37% had fair or poor results. Subtalar arthrosis noted on CT was the only finding that correlated with outcome. At the latest follow-up, 63% of patients had a deteriorated outcome score (P = 0.007); 47% of patients had excellent or good results. Subtalar arthrosis noted at the initial evaluation correlated with deterioration of outcome.

Discussion and Conclusion: The results of this sequential follow-up demonstrated that calcaneal fractures treated nonoperatively often result in pain and functional limitations that increase in the second decade after injury. Long-term and sequential follow-up of operative intervention is needed to determine whether surgical restoration of the subtalar joint can prevent the deterioration of results seen in this study. Poor results and second decade deterioration correlated with subtalar arthrosis.