Comparison of Functional Result and Prognostic Factors of Unilateral and Bilateral Calcaneal Fracture

Transcription

1 Comparison of Functional Result and Prognostic Factors of Unilateral and Bilateral Calcaneal Fracture Sunghwan Byun, DPM, PGY-4 St. Luke s Hospital, Allentown, PA Sangbong Ko, MD Department of Orthopedic / Daegu Catholic University Daegu / South Korea Sangwook Lee, MD Department of Orthopedic / Daegu Catholic University Daegu / South Korea

2 Disclosure <Comparison of Functional Result and Prognostic Factors of Unilateral and> Bilateral Calcaneal Fracture <Sunghwan Byun, DPM ; Sangbong Ko, MD ; Sangwook Lee, MD > My disclosure is in the Final AOFAS Program Book. I have no potential conflicts with this presentation.

3 Introduction Calcaneus Fracture 2% of all Fractures ( 65% of Tarsal bone Fracture ) Complex Anatomy and Uncertain prognosis Bilateral Calcaneus Fracture Rare Purpose Subject and Object Evaluation of Patients Prognostic Factors of Bilateral Calcaneus Fracture Compare the Prognosis between Unilateral and Bilateral Calcaneus Fracture

4 Material & Methods Inclusion & Exclusion Criteria From March 1985 to July Cases among 298 Cases Sex and Age Sex Male (63) Female (32) Age ± 9.47 ( ) year Inclusion Criteria 1. Bilateral 2. Operation Indication Even Unilateral 3. At least 1 ⅟₂ year follow up Etiology Fall Down 31 ( 97 % ) MVA 1 ( 3% ) Exclusion Criteria 1. Past Surgical History on Calcaneus 2. Secondary Gain 3. < 18 year old and 60 year old >

5 Material & Methods Within 2 weeks Approach Treatment protocol Lateral Approach ( by Palmer ) Extensile Lateral Approach ( by Benirsche) Closed Reduction / Percutaneous Pinning ORIF with Recon. Plate and Screw Below Knee Cast ( 6 weeks ) Postop Evaluation Radiographic : Böehler Angle (Preop, Postop 4 6 weeks, last follow up) Clinical : OPD Visit & Telephone Interview

6 Material & Methods CFSS ( Calcaneus Fracture Scoring System ) (by P.K Kerr et. Al.) 13 Others Creighton Nebraska Health Foundation Score Maryland Foot Score Small Sample Size Not Normal Distribution - Nonparametric Rank Test Linear Correlation Retrospective Study Statistical Study SPSS Version 9.0 p < Table Calcaneus Fracture Scoring System / CFSS Pain(36 point) At rest None 18 Slight 12 Moderate 6 Severe 0 On activity None 18 Slight 12 Moderate 6 Severe 0 Work(25 point) No change in job 25 Modification of job 16 Enforced change of job 8 Unable to work 0 Walking ( 25 point ) Walking aids ( 14 point ) No change in walking ability 25 Minimal restriction 16 Moderate restriction 8 Severe restriction 0 None 14 Occasional stick 10 Constant stick 6 2 sticks 3 Crutches 0 Table 1. The proposed calcaneal fracture scoring system

7 Results CFSS /VAS CFSS 82.66±16.8 1(34-100) CFSS Male Female P Value Bilateral Unilateral Bilateral Unilateral p - Value ± ± ±17.3 1(24-100) ± ± p value p = p =0.973 p = VAS 2.94± ±2.29 p = Sex P = Body Weight & CFSS Bilateral Unilateral ( p = ) ( p = ) p : probability Age & CFSS Bilateral Unilateral (p = 0.399) (p = 0.119) p : Probability

8 Result Smoking Associate Injury CFSS Smoking Non- Smoking p value CFSS Associate Not Associate p value Bilateral ± ± p = Bilateral ± ± 9.03 *p = 0.02 Unilateral ± ± p = Unilateral ± ± *p = p value p = p = p value p = p = 0.807

9 Conclusion This study shows the prognosis of both unilateral and bilateral calcaneal fracture are not correlated with factors such as smoking, age, sex and body weight The statistical study shows that there is no difference in prognosis between unilateral and bilateral calcaneus fracture. Both unilateral and bilateral fracture have poor prognosis via statistical study when the injury is combined with other lower extremity fracture.

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