Long-term results of surgically treated calcaneal fractures: an analysis with a minimum follow-up period of twenty years.

Purpose: Long-term results after treatment of calcaneal fractures are rare. For this reason, we conducted a retrospective follow-up after a minimum of 20 years post surgery.

Methods: Between 1990 and 1994, a total of 66 patients received surgical treatment for displaced calcaneal fractures. At that time, osteosynthesis was performed using small, one-third tubular plates. After collecting empirical data, we conducted a follow-up at least 20 years post surgery using X-ray imaging and clinical questionnaires (AOFAS and SF-36 questionnaire).

Results: It was possible to recruit a total of 22/66 patients (33 %) after a mean of 22 years (range, 20-24) post surgery. With regard to the AOFAS scores (mean value, 74 points), 12 showed very good or good results, four showed average and six poor results. Patients with orthopaedic shoes also had low AOFAS scores. The Boehler's angle had been increased from +2° prior to surgery to +21° post-operatively. At the time of follow-up, the mean value was +17°. The angle correlated with the AOFAS score. Also, the SF-36 physical score was clearly reduced when compared to a general population, and correlated significantly with the AOFAS score.

Conclusion: There is still no evidence that open reduction and internal fixation of calcaneal fractures results in better outcomes than conservative therapy. This has been confirmed by our long-term results that provided disillusioning results: in a small population, only 55 % of the patients showed very good or good clinical overall results. Furthermore, SF-36 showed impaired physical subscores, which correlated significantly with the AOFAS.