Long-term results and treatment recommendations for calcaneal fractures

Background. The long-term outcome (follow-up 82-154 months) of 167 patients with 181 displaced calcaneal fractures treated by open reduction and internal fixation (ORIF) in a level I trauma center (Berufsgenossenschaftliches Unfallkrankenhaus Hamburg, from January 2000 to December 2005) was analyzed in a retrospective cohort study. Methods. The study involved a comparative analysis of the preoperative and postoperative X-ray and computed tomography (CT) images, a clinical examination and the analysis by two standardized questionnaires, the American Orthopedic Foot and Ankle Society (AOFAS) and the Maryland foot score (MFS) on function and load bearing. Results. A special focus was on displaced, intra-articular calcaneal fractures (classified as Sanders type IV and Zwipp grades 11 and 12 points). Treatment results were not directly affected by injury severity. Only ten patients were in need of subtalar arthrodesis in the follow-up. A primary subtalar fusion was avoided and should only be an option in exceptional cases. Also primary bone grafting for defect filling appears unnecessary and was not implemented. No malunions, non-unions or refractures were detected.