There is a paucity of literature on the effect of calcaneal fractures on subtalar joint motion and patient satisfaction. The objective of this study was to determine the relationship between subtalar joint motion and outcome satisfaction in patients who had displaced intraarticular calcaneal fractures. The design of this study was a retrospective analysis from a randomized, controlled clinical trial. The setting was a Level I trauma center.
Of the 332 displaced intraarticular calcaneal fractures entered into the clinical trial and managed by the senior author, 244 fractures had subtalar joint motion measurements taken at least 12 weeks after fracture, and patient-oriented outcomes were reviewed at 2 years. Nonoperative treatment consisted of ice, elevation, and rest without closed reduction. In the operative group, an extended lateral approach was used with subchondral fixation, plating, and bone grafting when necessary. The Short Form 36 (SF-36), a validated visual analogue scale (VAS), and a gait analogue score measured patient satisfaction. Subtalar joint motion was recorded as percentages of the uninjured limb and grouped into quartiles.
The VAS, SF-36 (p <.0001), and the gait satisfaction score (p <.05) all increased significantly with increasing subtalar joint motion. Satisfaction on the VAS and SF-36 was significantly related to subtalar joint motion for men (p <.0001) and in the age groups 30 to 39 (p <.001) and 40 to 49 years (p <0.05). In non-Workman Compensation Board (WCB) clients, higher subtalar joint motion was significantly related to improved satisfaction on VAS and SF-36 (p <.005). Patient satisfaction was significantly related to subtalar joint motion as measured by the VAS when patients reported pre-injury workloads of moderate (p <.05) or heavy (p <.01) regardless of whether they were treated operatively (p <.05) or nonoperatively (p <.0005).
The amount of subtalar joint motion at least 12 weeks after displaced intraarticular calcaneal fracture is significantly related to patient satisfaction at 2 years regardless of the method of treatment.
[Show abstract][Hide abstract] ABSTRACT: Calcaneus fractures account for 1-2 % of all fractures. There are still controversies in treating calcaneus fractures between operative and non operative treatment. Both treatment protocols produce sequelae that may aff ect the individuals' life in many ways. There are some papers in the literature that implicate some factors that predict poor results in treatment of calcaneus fractures. Patients with high energy fractu- res, patients with Böhlers angle less than 0 degrees and patients whose fracture is classified in Sanders class 4 are most likely to have sequelae which need operative treatment. In treating sequelae caused by calcaneus fracture one must examine the patient and recognise the cause of the patient's symptom which very often is heel pain. Very often pain is caused by malalignment and widening of the heel. In situ fu- sion of the subtalar joint is therefore not the treatment of choice; instead one should realign the heel and fuse the subtalar joint. There are many reasons for heel pain after calcaneus fracture and the reason for the symptom must be recognised before the decision for treatment of the patient is made.
[Show abstract][Hide abstract] ABSTRACT: We describe an arthroscopic approach of subtalar release for post-traumatic subtalar stiffness that can allow early postoperative vigorous mobilization. The patient is placed in the lateral position. Subtalar arthroscopy is performed via the standard anterolateral portal at the angle of Gissane, the middle portal just distal and anterior to the tip of the lateral malleolus, and the posterolateral portal at the vertical limb of the old surgical scar, just above the posterosuperior tubercle of the calcaneus. Arthroscopic subtalar release is performed in stages. First, the fibrous bands at the sinus tarsi are debrided. The most lateral part of the interosseous talocalcaneal ligament is released. The dense fibrous tissue of the lateral subtalar gutter is then cleared. Most of the time, the subtalar motion gained at this stage is insignificant. At the second stage, the posterior capsule can be released and the fibrous tissue at the posterior corner of the joint can be debrided. Finally, the lateral subtalar capsule and lateral subtalar ligamentous structures are stripped from the lateral calcaneal cortical surface. Stripping should be done beyond the old surgical scar to release the adhesion of the surgical scar to the lateral calcaneal wall.
Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2007; 22(12):1364.e1-4. DOI:10.1016/j.arthro.2006.05.028 · 3.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The outcome after displaced intra-articular calcaneal fractures is influenced by the condition of the surrounding soft tissues. To avoid secondary soft tissue complications after surgical treatment, several less-invasive procedures for reduction and fixation have been introduced. The percutaneous technique according to Forgon and Zadravecz is suitable for all types of displaced intra-articular calcaneal fractures and was therefore introduced in our clinic. The aim of this study was to evaluate the long-term outcome of percutaneous treatment according to Forgon and Zadravecz in patients with displaced intra-articular calcaneal fractures.
A cohort of patients with displaced intra-articular calcaneal fractures treated with percutaneous surgery was retrospectively defined. Clinical outcome was evaluated by standardized physical examination, radiographs, three published outcome scores, and a visual analogue scale of patient satisfaction.
Fifty patients with 61 calcaneal fractures were included. After a mean follow-up period of 35 months, the mean values of the Maryland foot score, the Creighton-Nebraska score, and the American Orthopaedic Foot and Ankle Society score were 79, 76, and 83 points out of 100, respectively. The average visual analogue scale was 7.2 points out of 10. The average range of motion of the ankle joint was 90% of normal and subtalar joint movements were almost 70% compared with the healthy side or normal values. Superficial wound complications occurred in seven cases (11%) and deep infections in two (3%). A secondary arthrodesis of the subtalar joint was performed in five patients and was scheduled in four patients (15%).
Compared with the outcome of historic controls from randomized trials and meta-analyses, this study indicates favorable results for the percutaneous technique compared with the open technique. Despite similar rates of postoperative infection and secondary arthrodesis, the total outcome scores and preserved subtalar motion are overall good to excellent.
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