Session VII - Foot & Ankle

Age, Gender, Work Capability and Worker's Compensation in Patients with Displaced Intra-articular Calcaneal Fractures

Richard E. Buckley, MD; Ted V. Tufescu, B.Sc, Department of Surgery, University of Calgary, Alberta, Canada

Purpose: To determine work capability and return to functional status in patients with displaced intra-articular calcaneal fracture. Also, to determine basic demographic data to prognosticate which particular types of calcaneal fracture will have the worst outcome when followed for a minimum of two years.

Design: Prospective cohort of consecutive patients.

Setting: Level I Trauma Center

Patients: Population of 169 displaced intra-articular calcaneal fractures treated by a single surgeon.

Methods: Patients were randomly assigned to operative treatment (a lateral approach to the calcaneus) or were treated non-operatively. Patients age and work capability were recorded upon admission into the study. The type of fracture was noted as classified by Essex-Lopresti, Sanders, OTA (73-C1.1-1.2-1.3, C2.1-C2.2-C2.3). Subgroups were then created based on the five variables: age, work capability, gender, WCB ±, single or multiple limb trauma. All patients were followed for greater than 2 years.

Main Outcome Measurements:

• 1. Return to full time work measured in days.
• 2. Change in work capability.
• 3. SF-36.
• 4. Validated visual analogue scale.
• 5. Historic ROWE score done at 24 months and at later date whenever possible.

Results: Whether treated operatively or non-operatively, males always showed a significant decrease in their work capability after calcaneal fracture. In the conservatively treated group, females returned to full time work faster than males. Female patients treated conservatively also scored better on their SF-36 and their VAS surveys. With respect to work capability, the heavy labor groups were especially unable to get back to their previous work, although the limited labor group returned to full time work faster than all other groups. WCB patients regardless of treatment displayed a decrease in work capability post injury. They also perceived their status as worse than the non-WCB patients. Bi-lateral intra-articular calcaneal fracture patients did particularly poorly and always worse than the unilateral intra-articular calcaneal patient.

Discussion: Whether treated conservatively or operatively, medium and heavy labor patients took longer to return to full time work and suffered a larger decrease in work capability. Women seemed to do better regardless of type of care, operative or non-operative, as they were associated with lighter labor duties. If they were commonly doing light duties, they also had better success with non-operative care. WCB patients scored less well in all forms of self-assessment tests. Bilateral fractures do less well with respect to all outcome measures.

Conclusion: It appears that certain groups, such as males, multiplied injured patients and heavy laborers may have better outcomes with operative treatment, while females and non WCB patients may do better with non operative treatment. Males have a poorer prognosis than females, especially when returning to heavy labor work. Operatively treated patients generally return to work quicker but long-term outcomes varied depending on other demographic information.