O1421 FUNCTIONAL OUTCOME FOLLOWING OPERATIVE FIXATION OF INTRA-ARTICULAR CALCANEAL FRACTURES

Abstract

Aim: To identify factors which improved outcome following surgery. Method: Between 1994–2000, 28 patients with 30 displaced intra-articular fractures of the calcaneum were treated with open reduction and internal fix-ation at our hospital (mean, 45 years). We reviewed 20 patients within the Shropshire region over a 3.6 average follow-up period using 4 recognised hindfoot scoring systems. Patients were classified according to Sander’s classification with preoperative CT scans. The mechanism of injury and postoperative management was recorded. Clinical and radiographic assessments were also made. Results: Average follow up was 3.6 years. The overall surgical results were comparable of similar studies based upon the Maryland Foot Score (30% excellent, 35% good, 30% fair, 5% poor). 75% of our patients returned back to work within 6 months with an average of 5 months. 3 patients developed a superficial wound infection. Data analysis revealed that neither the age, energy of injury, time to surgery, time spent in plaster nor the time that physiotherapy was commenced had any significant bearing on functional outcome. However, early weightbearing at 6 weeks positively influenced outcome with all 4 scoring systems (p=0.01, 0.01, 0.02, 0.05) with a deterioration of outcome with delayed weightbearing. This was shown to be due to loss of sub-talar joint mobility (r=−0.74, p=0.001). Conclusions: We propose that good results can be obtained from internal fixation of intra-articular calcaneal fractures with a high probability of early return back to work. We recommend that patients be encouraged to weightbear at 6 weeks to optimise mobility at the subtalar joint.