Impact of Psychosocial and Economic Factors on Functional Outcomes After Operative Calcaneus Fractures.

Objectives: To report functional outcome scores after operative intraarticular calcaneus fracture and to determine risk factors associated with worse outcomes.

Design: Retrospective study.

Setting: Urban Level 1 trauma center.

Patients And Participants: Ninety-six patients with 114 calcaneus fractures treated by a single surgeon over a 14-year period.

Intervention: Surgical treatment with open reduction and internal fixation with lateral extensile approach or percutaneous reduction and fixation.

Main Outcome Measurements: Functional outcome scores as assessed by the Musculoskeletal Function Assessment (MFA) and the Foot Function Index (FFI) after mean 56 months follow-up.

Results: Seventy-two patients (75%) completed functional outcome questionnaires. Patients with functional outcome data were more often employed (86% vs. 67%, P = 0.07), but were no different in terms of age, sex, medical history, mechanism of injury, or injury characteristics. The mean FFI score was 30 (range: 2-89), and the mean MFA score was 28 (range: 2-80). One-third of patients reported scores >30 on the FFI, MFA, or both. Age, sex, tobacco use, mechanism of injury, fracture pattern, open injury, and postoperative infection were not associated with outcome scores. Alcohol abuse and failure to return to work were associated with worse (higher) FFI scores. Alcohol abuse, psychiatric illness, unemployment (before and after injury), polytrauma, and posttraumatic osteoarthrosis were associated with worse (higher) MFA scores.

Conclusions: Polytrauma, alcohol abuse, psychiatric illness, work status, and posttraumatic osteoarthrosis were predictors of poor functional outcomes. The findings of this study add to previous literature that has demonstrated the importance of social, behavioral, and environmental factors on recovery after orthopaedic injury.

Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.