Background: Operative intervention is an accepted treatment for
fractures of the calcaneus. However, the literature discourages surgery for
these fractures in the elderly. The purpose of this paper was to review the
outcomes of surgical treatment of displaced fractures of the calcaneus in
elderly patients.
Methods: Between November 1987 and June 2000, forty-two patients
(forty-four fractures) who were sixty-five years of age or older underwent
surgery for a calcaneal fracture. The mechanism of injury, fracture pattern,
and medical comorbidities were recorded. Thirty-five patients with a total of
thirty-seven fractures were available for follow-up, which was conducted with
physical and radiographic examinations and outcomes assessment with the Short
Form-36 (SF-36), the American Orthopaedic Foot and Ankle Society
ankle-hindfoot scale, and the Short Musculoskeletal Function Assessment
survey.
Results: The minimum duration of follow-up was two years, and the
average duration was forty-four months. All but one fracture (97% of the
fractures) healed at an average of 110 days. The average active range of
motion was 38° of plantar flexion, 10° of dorsiflexion, 16° of
inversion, and 11° of eversion. The average American Orthopaedic Foot and
Ankle Society score was 82.4 points, the average SF-36 score was 52.8 points,
and the average Short Musculoskeletal Function Assessment score was 20.4
points. Posttraumatic subtalar arthritis developed in twelve patients. There
were twelve minor complications and four major complications (three cases of
osteomyelitis and one nonunion), all of which were treated successfully.
Conclusions: Open reduction appears to be an acceptable method of
treatment for displaced calcaneal fractures in elderly patients. Careful
patient selection is necessary because individuals presenting with severe
osteopenia, those who are unable to walk or are able to walk only about the
house, and those with a medical condition that precludes surgery may be better
candidates for nonoperative care.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.