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Long-Term Functional Outcomes After Operative Treatment for Intra-Articular Fractures of the Calcaneus
Michael Q. Potter, MD1; James A. Nunley, MD1
1 Department of Orthopaedic Surgery, Duke University Medical Center, Box 2923, Durham, NC 27710. E-mail address for J.A. Nunley: james.nunley@duke.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
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Investigation performed at Duke University Medical Center, Durham, North Carolina

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Aug 01;91(8):1854-1860. doi: 10.2106/JBJS.H.01475
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Background: Calcaneal fractures can have long-term consequences in terms of pain and disability. Comparative studies have suggested that operative treatment of these fractures may result in better outcomes than nonoperative treatment; however, to our knowledge, the long-term outcomes of operative treatment of calcaneal fractures have not been reported for a large cohort of patients.

Methods: One hundred and fifty-seven patients with calcaneal fractures were managed at our institution between January 1, 1989, and April 30, 2003. Seventy-three patients who were managed operatively for eighty-one intra-articular calcaneal fractures responded to a functional questionnaire that included the adjusted American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (subjective component only), the Foot Function Index, and the calcaneal fracture scoring system at a median of 12.8 years (range, 5.0 to 18.5 years) after the injury.

Results: In our study population, the mean adjusted American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 65.4 (95% confidence interval, 60.6 to 70.2), the mean Foot Function Index score was 20.5 (95% confidence interval, 16.6 to 24.4), and the mean calcaneal fracture scoring system score was 69.3 (95% confidence interval, 63.6 to 74.9). Patients who had sustained the calcaneal fracture as a result of a motor-vehicle accident rather than a fall reported significantly worse outcomes on two of three scales (p = 0.04 for the adjusted American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, p = 0.05 for the Foot Function Index, and p = 0.35 for the calcaneal fracture scoring system), but this analysis was limited by the exclusion of twenty-four patients because of crush injuries (two) or unavailable documentation of the mechanism of injury (twenty-two).

Conclusions: The long-term outcomes of operative treatment described in the present report are comparable with the long-term outcomes previously reported among smaller patient cohorts. Additional investigation is required to determine why patients with fractures that resulted from a motor-vehicle accident reported worse outcomes than patients with fractures that resulted from a fall.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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