Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors.

Forty-four patients who had had fifty-two calcaneal fractures were managed with open reduction and internal fixation. The results were reviewed retrospectively, between four and fourteen years after the operation, with use of an evaluation system for the hindfoot and with plain radiographs. The characteristics of the patients that were associated with an unsatisfactory outcome were an age of more than fifty years, a greater body weight, work involving strenuous labor, and increased time missed from work due to the injury. Other prognostic variables associated with an unsatisfactory result included subtalar incongruity, osteoarthrosis of the talonavicular joint and the ankle, an increased heel width, a decreased fibulocalcaneal space, and a decreased Böhler-angle ratio of the fractured to the normal side. The heel height, fat-pad height, arch angle, talocalcaneal angle, and length of the Achilles-tendon fulcrum were not related to the outcome. Patients who had had a tongue-type fracture had a better result than those who had had a central depression fracture, while those who had had a central depression fracture had a better outcome than those who had had a comminuted fracture. Comminution of tongue and large central-depression fractures was associated with a worse prognosis. The most common most painful area in the patients who had a satisfactory outcome was the lateral aspect of the hindfoot, while in those who had an unsatisfactory result, it was the heel pad.