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Factors Affecting Long-Term Treatment Results of Displaced Intraarticular Calcaneal Fractures: A Post Hoc Analysis of a Prospective, Randomized, Controlled Multicenter Trial

Ågren, Per-Henrik MD*; Mukka, Sebastian MD; Tullberg, Tycho MD, PhD; Wretenberg, Per MD, PhD§; Sayed-Noor, Arkan S. MD, PhD, FRCS

doi: 10.1097/BOT.0000000000000149
Original Article

Objectives: To study the factors affecting long-term treatment results of displaced intraarticular calcaneal fractures (DIACFs).

Design: A post hoc analysis.

Settings: Tertiary care teaching hospitals.

Patients: Eight to twelve years of results from a randomized controlled multicenter trial of operative versus nonoperative treatment (n = 56) were divided into 2 groups: the superior 50% results (n = 28) and the inferior 50% results (n = 28), regardless of the treatment given. The determinant of this division was a visual analog score for pain and function.

Interventions: The operative treatment consists of open reduction and internal fixation, whereas the nonoperative treatment consists of nonweight bearing and early range of motion exercise.

Main Outcome Measurements: A visual analog score for pain and function, the short-form 36 (SF-36) general health outcome questionnaire, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, and Olerud-Molander score. We compared age, sex, fracture type (Sanders classification), treatment given, Böhler angle, residual articular surface step-off at healing, type of occupation, and injury insurance between the 2 groups.

Results: Patients of the superior group had higher physical SF-36, AOFAS, and Olerud-Molander score than in the inferior group. Operative treatment, better Böhler angle and articular surface restoration, light labor/retirement, and absence of injury insurance were more common in the superior group. Age, sex, pretreatment Böhler angle, and fracture type were comparable in the superior and inferior groups.

Conclusions: The decision making for definitive treatment of intraarticular calcaneal fractures is multifactorial with a spectrum of results and trends such as patient demographic features that should be considered in choosing the best treatment option.

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

*Stockholm Fotkirurgklinik, Sofiahemmet, Stockholm, Sweden;

Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Umeå, Sweden;

Stockholm Spine Center, Stockholm, Sweden; and

§Department of Molecular Medicine and Surgery (Orthopaedics), Karolinska Institute, Stockholm, Sweden.

Reprints: Arkan S. Sayed-Noor, MD, PhD, FRCS, Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Umeå 901 87, Sweden (e-mail:

The authors report no conflict of interest.

Ethical approval was obtained from Karolinska Institute (number 93:282), Stockholm, Sweden.

Presented at the Annual Meeting of the Swedish Orthopaedic Association, August 2013, Uppsala, Sweden.

Accepted April 29, 2014

© 2014 by Lippincott Williams & Wilkins