Affiliations: [a] Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany | [b] Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland
Correspondence:
[*]
Corresponding author: Priv.-Doz. Dr. Ralph Gaulke, Department of Orthopaedic Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, D-30525 Hannover, Germany. Tel.: +49 511 532 2026; Fax: +49 511 532-5877; E-mail:gaulke.ralph@mh-hannover.de
Abstract:
OBJECTIVE: The current retrospective case-control study examines
the prognostic value of radiologic parameters for long-term clinical outcome
assessment after a calcaneus fracture. METHODS: In the authors' trauma department 262 adult patients with
an isolated calcaneus fracture were treated from 1995 to 2005. Using
conventional x-ray and computed tomography imaging. the calcaneal fractures
were classified according to Sanders system. In addition, Boehler's and
Gissane's angles were measured before and after therapy and the Larsen stage
of subtalar arthrosis was determined. After a mean follow-up interval of 9.5
years, 44 patients were available for clinical and radiological assessment. RESULTS: At the time of trauma the average age of the study group
was 52 (range, 29-79) years. Thirty-seven patients were treated
operatively and seven conservatively. Patients with a negative Boehler's
angle, upon admission, exhibited significantly worse results using four of
the five clinical scoring systems than patients with a preserved or slight
reduced Boehler's angle. Operative treatment in patients whose Boehler's
angle was elevated to normal range or beyond exhibited %worse
better
results than
patients with
an over-correction of
Boehler's angle. In 11 cases, two
primary and nine secondary subtalar arthrodeses were performed. The degree
of subtalar arthrosis as per Larsen was increased 2.54 ± 1.14 in the
course of hospital admission, arthrodesis and/or follow up examination. The
results show no significant difference between operative and conservative
treatment. CONCLUSIONS: Boehler's angle at time of admission appears to be a
valuable prognosticator for functional long-term results after calcaneus
fracture. An operative over-correction of a reduced Boehler's angle should
be avoided.
