TREATMENT OF CALCANEAL FRACTURES IN THE ELDERLY: A 14 YEAR REVIEW

Abstract

As the population ages, we can expect to see more elderly patients with calcaneal fractures. Age alone does not reflect a person’s health or functional status, and should not, therefore, be used as a contraindication to surgical fixation. We report on the management of all patients over 65 years with calcaneal fractures receiving treatment at our institution over a 14-year period.

Seventy-three patients > 65 years old with 76 calcaneal fractures treated from 1990 to 2004 were identified from a trauma database. A review of clinical notes was performed; demographics, co-morbidities, mechanism of injury, associated injuries, and management data were collected. For patients receiving operative treatment the fracture classification, operative indications, treatment and outcomes were reviewed.

Twenty-seven patients with 29 fractures were treated without fixation, and 46 patients with 47 fractures were treated with fracture fixation. When compared with non-operatively treated patients, those treated operatively had lower mean injury severity scores (8.9 vs. 17.2) and fewer mean co-morbidities (1.0 vs. 2.2).

Fractures were treated operatively either with an extensile lateral approach, small incision fixation, or a push screw. Follow-up (two weeks to 50 months) was available on all patients treated operatively, and radiographic follow-up was available on 32 patients. Wound infection and persistent drainage was seen in three and two patients, respectively. There was one non-union. One subtalar fusion was required. Eleven patients subsequently required plate removal.

This retrospective review demonstrates that operative treatment of calcaneal fractures in carefully selected, elderly patients can result in good outcomes with acceptable complication rates. The complication profile for patients over 65 with calcaneus fractures appears to be similar to younger patients.