Long-term mortality after internal fixation of calcaneal fractures: a retrospective study.

The aim of this study was to describe the mortality risk after calcaneal fractures which required internal fixation and evaluate predictors of survival. During the observed 11-year period (1995-2006), 178 consecutive patients underwent operative fixation for displaced intra-articular calcaneal fractures. Patient demographics, mechanism of injury, and social deprivation (Carstairs index) were recorded. Mortality was obtained from patient notes. Causes of mortality were obtained from the national database. Standardised mortality ratios (SMRs) were calculated. Ten patients were lost to follow-up. Of the remaining 168 patients, the mean age was 41 (range 14-77) years. Females [n = 33, 46.3 standard deviation (SD) 17.1 years] were significantly (difference 6.5 years, 95% CI 1.1-11.9, p = 0.02) older than male patients (n = 135, 39.8 SD 13.4 years). During the study period, 28 patients died. The overall unadjusted survival rate was 92.8% (95% CI 87.0-98.7) at 10 years and 81.9% (95% CI 76.2-87.6) at 15 years. The SMR at 10 years was 5.2 (95% CI 2.8-13.3) for males and 1.4 (95% CI - 4.9 to 7.8) for females. Cox regression analysis demonstrated male gender to be a significant predictor of mortality (hazard ratio 2.77, 95% 3.83-9.65, p = 0.01) adjusted for age and social deprivation. Male patients requiring internal fixation of intra-articular calcaneal fractures have a significantly increased mortality risk compared to an age- and gender-matched population. Further study is warranted to fully identify the reasons behind this, which may enable their survival to be improved.Level of evidence Retrospective Cohort study, Level 4.