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International Orthopaedics
Published in: International Orthopaedics 9/2018

Open Access 01-09-2018 | Original Paper

Association of pre-treatment radiographic characteristics of calcaneal fractures on patient-reported outcomes

Authors: Georgios Alexandridis, Amy C. Gunning, Ger D. J. van Olden, Egbert-Jan M. M. Verleisdonk, Michiel J. M. Segers, Luke P. H. Leenen

Published in: International Orthopaedics | Issue 9/2018

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Abstract

Purposes

Calcaneal fractures are known to influence patients’ quality of life negatively. The type of calcaneal fracture might have a relation with the patient outcome. To inform patients in an early stage on how their calcaneal fracture may affect their lives, knowledge of the fracture characteristics is necessary. This study evaluates the association of type of calcaneal fracture, measurement of conventional radiograph angles, and the Sanders classification with patient-reported outcomes.

Material and methods

This is a retrospective study based on a prospective trauma database including all patients aged 16 years or older with a calcaneal fracture admitted in one of the participating trauma level I or II hospitals. Patients, trauma, and fracture characteristics were collected. The conventional radiographs were evaluated in which type of fracture, and Böhler’s, Gissane’s, and calcaneal compression angles were determined. Also, the CT images were classified according to Sanders. In addition, displaced intra-articular calcaneal fractures were separately analyzed. A questionnaire was sent to the included patients that consisted of the EQ-6D, patient-specific characteristics, satisfaction with foot appearance and wearable shoe range, complications, and capability to work.

Results

A total of 396 patients with 442 calcaneal fractures were eligible for follow-up. Two hundred fifteen patients with 246 calcaneal fractures participated. Patients with a calcaneal fracture into the talar surface reported a worse quality of life (p = 0.010), were less satisfied with their feet (p < 0.001), and had more complications (p = 0.001–0.006); extra-articular fractures had significantly opposite result. A negative Böhler’s or calcaneal compression angle was related with unfavourable outcomes. Sanders classification was not related with any patient-reported outcome.

Conclusion

Our study implies that patients with an intra-articular calcaneal fracture into the talar surface have a lower health-related quality of life, will be less satisfied with the outcome of their feet, and have more complications compared to patients with other type of calcaneal fractures. Furthermore, the Sanders classification was not associated with the patient-reported outcomes.
Literature
1.
Brauer CA, Manns BJ, Ko M, Donaldson C, Buckley R (2005) An economic evaluation of operative compared with nonoperative management of displaced intra-articular calcaneal fractures. J Bone Joint Surg Am 87(12):2741–2749CrossRefPubMed
2.
3.
Mitchell MJ, McKinley JC, Robinson CM (2009) The epidemiology of calcaneal fractures. Foot (Edinb) 19(4):197–200CrossRef
4.
Van Hoeve S, de Vos J, Verbruggen JP, Willems P, Meijer K, Poeze M (2015) Gait analysis and functional outcome after calcaneal fracture. J Bone Joint Surg Am 97(22):1879–1888CrossRefPubMed
5.
O’Brien J, Buckley R, McCormack R, Pate G, Leighton R, Petrie D, Galpin R (2004) Personal gait satisfaction after displaced intraarticular calcaneal fractures: a 2-8 year followup. Foot Ankle Int 25(9):657–665CrossRefPubMed
6.
Alexandridis G, Gunning AC, Leenen LP (2015) Patient-reported health-related quality of life after a displaced intra-articular calcaneal fracture: a systematic review. World J Emerg Surg 10:62CrossRefPubMedPubMedCentral
7.
Van Tetering EA, Buckley RE (2004) Functional outcome (SF-36) of patients with displaced calcaneal fractures compared to SF-36 normative data. Foot Ankle Int 25(10):733–738CrossRefPubMed
8.
Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R (2002) Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 84-A(10):1733–1744CrossRefPubMed
9.
Weldring T, Smith SMS (2013) Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Serv Insights 6:61–68PubMedPubMedCentral
10.
Alexandridis G, Gunning AC, van Olden GDJ, Verleisdonk EJMM, Segers MJM, Leenen LPH (2017) A trauma system wide evaluation of the demographic, injury and fracture characteristics of patients with calcaneal fractures: a comparison of trauma level I and II centers. Clin Res Foot Ankle 5:2
11.
Loucks C, Buckley R (1999) Bohler’s angle: correlation with outcome in displaced intra-articular calcaneal fractures. J Orthop Trauma 13(8):554–558CrossRefPubMed
12.
Persson J, Peters S, Haddadin S, O'Loughlin PF, Krettek C, Gaulke R (2015) The prognostic value of radiologic parameters for long-term outcome assessment after an isolated unilateral calcaneus fracture. Technol Health Care 23(3):285–298CrossRefPubMed
13.
Schepers T, Ginai AZ, Mulder PG, Patka P (2007) Radiographic evaluation of calcaneal fractures: to measure or not to measure. Skelet Radiol 36(9):847–852CrossRef
14.
Rubino R, Valderrabano V, Sutter PM, Regazzoni P (2009) Prognostic value of four classifications of calcaneal fractures. Foot Ankle Int 30(3):229–238CrossRefPubMed
15.
Efficace F, Bottomley A, Osoba D, Gotay C, Flechtner H, D’haese S et al (2003) Beyond the development of health-related quality-of-life (HRQOL) measures: a checklist for evaluating HRQOL outcomes in cancer clinical trials—does HRQOL evaluation in prostate cancer research inform clinical decision making? J Clin Oncol 21(18):3502–3511CrossRefPubMed
16.
Lcd-9-cm: International Classification of Diseases, 9th Revision, Clinical Modification (1996) Salt Lake City, Utah: Medicode
17.
American Society of Anesthesiologists (1963) New classification of physical status. Anesthesiology 24:III
18.
Association for the Advancement of Automotive Medicine: The Abbreviated Injury Scale 1990 Revision-Update 98 Barrington (1998) IL: Association for the Advancement of Automotive Medicine
19.
Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–196CrossRefPubMed
20.
Sanders R (1992) Intra-articular fractures of the calcaneus: present state of the art. J Orthop Trauma 6(2):252–265CrossRefPubMed
21.
Wilmott H, Stanton J, Southgate C (2012) Böhler’s angle—what is normal in the uninjured British population? Foot Ankle Surg 18:187–189CrossRef
22.
23.
Shoukry FA, Aref YK, Sabry AAE (2012) Evaluation of the normal calcaneal angles in Egyptian population. Alexandria J Med 48(2):91–97CrossRef
24.
Harrison MJ, Davies LM, Bansback NJ, Ingram M, Anis AH, Symmons DP (2008) The validity and responsiveness of generic utility measures in rheumatoid arthritis: a review. J Rheumatol 35(4):592–602PubMed
25.
Honkavaara N, Al-Ani AN, Compenfeldt P, Ekström W, Hedström M (2016) Good responsiveness with EuroQol 5-dimension questionnaire and short form (36) health survey in 20-69 years old patients with a femoral neck fracture: a 2-year prospective follow-up study in 182 patients. Injury 47(8):1692–1697CrossRefPubMed
26.
Hung MC, Lu WS, Chen SS, Hou WH, Hsieh CL, Wang JD (2015) Validation of the EQ-5D in patients with traumatic limb injury. J Occup Rehabil 25(2):387–393CrossRefPubMed
27.
Hurst NP, Kind P, Ruta D, Hunter M, Stubbings A (1997) Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 36(5):551–559CrossRefPubMed
28.
Obradovic M, Lal A, Liedgens H (2013) Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain. Health Qual Life Outcomes 11:110CrossRefPubMedPubMedCentral
29.
Krabbe PF, Stouthard ME, Essink-Bot ML, Bonsel GJ (1999) The effect of adding a cognitive dimension to the EuroQol multiattribute health-status classification system. J Clin Epidemiol 52(4):293–301CrossRefPubMed
30.
Williams A (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208CrossRef
31.
Lamers LM, Stalmeier PF, McDonnell J, Krabbe PF, van Busschbach JJ (2005) Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff. Ned Tijdschr Geneeskd 149(28):1574–1578PubMed
32.
Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE et al (1998) Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. J Clin Epidemiol 51:1171–1178CrossRefPubMed
33.
Hoeymans N, van Lindert H, Westert GP (2005) The health status of the Dutch population as assessed by the EQ-6D. Qual Life Res 14(3):655–663CrossRefPubMed
34.
Kind P, Dolan P, Gudex C, Williams A (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 316(7133):736–741CrossRefPubMedPubMedCentral
35.
Dawson J, Boller I, Doll H, Lavis G, Sharp RJ, Cooke P, Jenkinson C (2012) Factors associated with patient satisfaction with foot and ankle surgery in a large prospective study. Foot (Edinb) 22(3):211–218CrossRef
36.
Su Y, Chen W, Zhang T, Wu X, Wu Z, Zhang Y (2013) Bohler’s angle’s role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study. BMC Surg 13:40CrossRefPubMedPubMedCentral
37.
Sayed-Noor AS, Agren PH, Wretenberg P (2011) Interobserver reliability and intraobserver reproducibility of three radiological classification systems for intra-articular calcaneal fractures. Foot Ankle Int 32:861–866CrossRefPubMed
38.
Bhattacharya R, Vassan UT, Finn P, Port A (2005) Sanders classification of fractures of the os calcis. An analysis of inter- and intraobserver variability. J Bone Joint Surg Br 87(2):205–208CrossRefPubMed
39.
Humphrey CA, Dirschl DR, Ellis TJ (2005) Interobserver reliability of a CT-based fracture classification system. J Orthop Trauma 19(9):616–622CrossRefPubMed
40.
Otero JE, Westerlind BO, Tantavisut S, Karam MD, Phisitkul P, Akoh CC, Gao Y, Marsh JL (2015) There is poor reliability of Böhler’s angle and the crucial angle of Gissane in assessing displaced intra-articular calcaneal fractures. Foot Ankle Surg 21(4):277–281CrossRefPubMed
41.
Ebraheim NA, Elgafy H, Sabry FF, Freih M, Abou-Chakra IS (2000) Sinus tarsi approach with trans-articular fixation for displaced intra-articular fractures of the calcaneus. Foot Ankle Int 21(2):105–113CrossRefPubMed
42.
Leung KS, Yuen KM, Chan WS (1993) Operative treatment of displaced intra-articular fractures of the calcaneum. Medium-term results. J Bone Joint Surg Br 75(2):196–201CrossRefPubMed
43.
Kinner B, Schieder S, Müller F, Pannek A, Roll C (2010) Calcaneocuboid joint involvement in calcaneal fractures. J Trauma 68(5):1192–1199CrossRefPubMed
44.
Alexandridis G, Gunning AC, Leenen LP (2016) Health-related quality of life in trauma patients who sustained a calcaneal fracture. Injury 47(7):1586–1591CrossRefPubMed
45.
Kristman V, Manno M, Côté P (2004) Loss to follow-up in cohort studies: how much is too much? Eur J Epidemiol 19(8):751–760CrossRefPubMed
Metadata
Title
Association of pre-treatment radiographic characteristics of calcaneal fractures on patient-reported outcomes
Authors
Georgios Alexandridis
Amy C. Gunning
Ger D. J. van Olden
Egbert-Jan M. M. Verleisdonk
Michiel J. M. Segers
Luke P. H. Leenen
Publication date
01-09-2018
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 9/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-018-3852-8

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