Radiological and Clinical Effects of Operative Treatment on Calcaneus Fractures
Received Date: March 17, 2021; Published Date: March 24, 2021
Background: Study was conducted to determine whether operative treatment for intraarticular calcaneus fractures results in improvement of post-operative Bohler’s angle (BA) and if the pre and postoperative measurements of BA can be used as prognostic factor for clinical outcome.
Methods: This retrospective study was conducted at orthopedic department in Hamad General Hospital, Doha, Qatar. The fractures were classified according to BA (Class A: > 16°; Class B: 0 - 15°; Class C: < 0°). The pre and immediate postoperative radiographs were assessed. Minimum follow up period for assessing clinical outcome was restricted to one year. Patients were telephonically followed up and assessed using the Foot Function Index and American Orthopedic Foot and Ankle Society Ankle Hind Foot Score by two independent observers.
Result and Discussion: 131 intra-articular calcaneus fractures were operated from 117 patients during the study period. Of these, 100 fractures from 96 patients were followed up. Kappa value for inter-observer reliability was 0.6258 (preoperative) and 0.6478 (postoperative). The Cohen kappa coefficient for intra- observer reproducibility was 0.6141 (preoperative) versus 0.6672 (postoperative) measurement of BA. Quantitative analysis was done using the paired t-test. The mean improvement in BA was found to be 13.14 for class A, 20.24 for class B, and 44.75 in class C. The mean AOFAS score for class A, B and C was found to be 46.38, 40.98, and 26.23 respectively. Likewise, the mean FFI was 25.66, 31.42, and 57.63 for class A, B and C respectively.
Conclusion: There was statistically significant improvement in BA among all classes. We conclude that surgical fixation is indicated if the preliminary angle is 0-25° and it results in good radiologic and functional outcome and grading system of BA can be predictably used as a prognostic indicator.
Keywords: Calcaneus; Fractures; Bohler’s angle; Operative; Non-operative; functional; Outcome