Internal fixation may be an option for older patients with displaced cancaneal fractures

Gaskill T. J Bone Joint Surg. 2010. doi:10.2106/JBJS.J.00089.

A study conducted by Duke University Medical Center investigators shows significantly better clinical outcomes for older patients who undergo internal fixation for intra-articular calcaneal fractures compared with younger patients and finds similar complication rates between the groups.

Trevor Gaskill, MD, and colleagues compared the outcomes of 96 patients aged 50 years or older who had internal fixation for intra-articular calcaneal fractures with those of 50 patients who were younger than 50 years and underwent the procedure. The patients were followed for a mean of 8.98 years, according to the study abstract.

The investigators discovered that the older cohort had an a higher average adjusted AOFAS score (75 vs. 64) and mean calcaneal fracture scoring system score (76 vs. 66) postoperatively compared with the younger group. In addition, the study revealed an average Foot Function Index of 15 for the older group and 24 for the younger group. The investigators also discovered that 8% of cases in the older group were converted to a subtalar fusion compared with 15% in the younger group.

“In this series, outcomes of older patients are at least equivalent to those of younger patients undergoing internal fixation for an intra-articular calcaneal fracture,” the investigators wrote. “Operative intervention appears to be a reasonable option for displaced calcaneal fractures in older patients. Physiologic age should be considered when evaluating older patients, and individualized treatment plans remain critical because patients with low physical demands or who have medical complications may be better candidates for nonoperative treatment.”