Determination of prognostic factors in calcaneal fractures

ABSTRACT Determination of Prognostic Factors in Calcaneal Fractures Objective: The calcaneus bone, together with other anatomical structures in the foot and ankle, is involved in a strong biomechanical harmony and functional correlation in bearing weight and enabling movement in the foot. Calcaneal fractures generally occur after high-energy trauma, such as falls from a height. The follow-up and treatment process after calcaneal fractures remains clinically important in terms of both functional and structural recovery. The study prospectively evaluated the prognostic factors affecting clinical outcomes by following up patients treated conservatively and surgically for calcaneal fractures for one year. At the same time, the relationship between the volumetric change of the calcaneus measured by tomography after conservative or surgical treatment in patients with calcaneal fractures and clinical and functional outcomes was evaluated. Materials and Methods: At the Orthopedics and Traumatology Clinic of Inönü University Faculty of Medicine, the clinical, functional, and radiological measurement results of patients who underwent conservative or surgical procedures for calcaneal fractures as of October 2023 were prospectively examined. Patients were periodically called for follow-up visits at 3 months, 6 months, and 12 months. Functional assessments, including VAS, AOFAS, FAAM, and SF-12, were performed alongside physical examinations. At their final follow-up (12 months), all patients underwent computed tomography (CT) scans of both feet. Results: The mean age of the 38 patients included in the study was 46 (18–77), and the mean follow-up period was 12 months. Thirty-two patients were male and 6 were female. Six cases were treated conservatively and 32 were treated surgically. Of the patients who underwent surgery, 25 underwent open reduction internal fixation (ORIF) and 7 underwent screw fixation. Eighteen patients were smokers and 9 had multiple trauma. The average body mass index was 23 (20–30). According to the Sanders classification, 22 fractures were classified as Type 2, 8 as Type 3 and 8 as Type 4. Partial weight bearing was initiated on average on the 45th day, and full weight bearing on average on the 90th day. While 28 patients had intra-articular step-up before treatment, intra-articular alignment was achieved in all patients at follow-up. Subtalar arthrosis developed in 21 patients during follow-up. Additionally, 11 patients required a change in shoe size, and a significant increase in calcaneal volume was detected after surgery. Conclusion: Our study, found an increase in calcaneal volume in patients following calcaneal fracture surgery. The early detection of volume increase after calcaneal fracture surgery and ensuring appropriate footwear selection were shown to have a positive effect on patients' clinical and functional recovery. Key words: Calcaneal fractures, Open reduction internal fixation, Sanders classification, Calcaneal volume, Clinical and functional recovery