The Journal of Bone and Joint Surgery, Vol 75, Issue 3 342-354, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors
D Paley and H Hall
Division of Orthopaedic Surgery, Women's College Hospital, University of Toronto, Ontario, Canada.
Forty-four patients who had had fifty-two calcaneal fractures were managed
with open reduction and internal fixation. The results were reviewed
retrospectively, between four and fourteen years after the operation, with
use of an evaluation system for the hindfoot and with plain radiographs.
The characteristics of the patients that were associated with an
unsatisfactory outcome were an age of more than fifty years, a greater body
weight, work involving strenuous labor, and increased time missed from work
due to the injury. Other prognostic variables associated with an
unsatisfactory result included subtalar incongruity, osteoarthrosis of the
talonavicular joint and the ankle, an increased heel width, a decreased
fibulocalcaneal space, and a decreased Bohler-angle ratio of the fractured
to the normal side. The heel height, fat-pad height, arch angle,
talocalcaneal angle, and length of the Achilles-tendon fulcrum were not
related to the outcome. Patients who had had a tongue-type fracture had a
better result than those who had had a central depression fracture, while
those who had had a central depression fracture had a better outcome than
those who had had a comminuted fracture. Comminution of tongue and large
central-depression fractures was associated with a worse prognosis. The
most common most painful area in the patients who had a satisfactory
outcome was the lateral aspect of the hindfoot, while in those who had an
unsatisfactory result, it was the heel pad.
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