The Association Between Subtalar Joint Motion and Outcome Satisfaction in Patients with Displaced Intraarticular Calcaneal Fractures
Department of Surgery, Foothills Hospital, Calgary, Alberta, Canada. Foot & Ankle International
(Impact Factor: 1.51).
09/2004; 25(9):666-73. DOI: 10.1177/107110070402500912
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.
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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.
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ABSTRACT: Patients' satisfaction with gait after calcaneal fracture has rarely been studied. The objective of this paper was to determine how patient demographics, fracture type and treatment affected gait satisfaction after displaced intraarticular calcaneal fractures. The design of the study is a prospective randomized trial performed in four Level I trauma centers.
Three hundred and nineteen patients with 351 radiographically proven displaced intraarticular calcaneal fractures (DIACF) were randomly assigned to open reduction and internal fixation (ORIF), or nonoperative treatment. A 2- to 8-year follow-up was obtained, with patients completing SF-36 and a validated visual analogue scale to assess personal gait satisfaction. The final joint positions were confirmed using plain radiographs and CT scans for both treatment arms. Examination using a one-way analysis-of-variance was performed to determine if statistical differences existed in personal gait satisfaction between the treatment arms.
Personal gait satisfaction scores were not significantly different between those DIACF treated with ORIF and those treated nonoperatively at 2- to 8-year follow-up. In patients treated with ORIF, improved personal gait scores were reported in those who were younger than 30 years of age, were non-WCB, had jobs requiring a moderate work-load before injury, and had Bohler angles restored to above 0 degrees. Factors not found to be significant in gait satisfaction included unilateral or bilateral calcaneal fractures, quality of initial reduction, and sex of the patient.
Subcategories determined that younger patients who were self-employed and treated operatively had improved gait scores. Treatment (operative or nonoperative) of calcaneal fractures did not affect gait satisfaction according to patient outcome scores.
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ABSTRACT: BACKGROUND: Calcaneal fractures comprise 1 to 2 percent of all fractures. Approximately 75% of calcaneal fractures are intra-articular. The management of intra-articular calcaneal fractures remains controversial. Nonoperative treatment options include elevation, ice, early mobilization, and cyclic compression of the plantar arch. Operative treatment options include closed reduction and percutaneous pin fixation, open reduction and internal fixation, and arthrodesis. The effect of operative versus nonoperative treatment has been the focus of several comparative studies. OBJECTIVE: This study was designed to determine the effect of operative treatment compared with nonoperative treatment on the rate of union, complications, and functional outcome after intra-articular calcaneal fracture in adults.
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