2018, Vol. 2 Issue 4, Part A
The calcaneus (os calcis) is the largest and most often fractured tarsal bone. It is the major weight bearing osseous structure of the foot and is one of the components of the tri-tarsal articulation and has important functional tasks about normal ambulation. So, any fracture of calcaneus can cause subtalar arthritis and leads to walking on uneven surface extremely painful. Calcaneal fractures account for approximately 2% of all and 60% of all major tarsal fractures, 10% have associated spine fractures and 26% are associated with other extremity injuries. Historically most fractures were treated nonoperatively because open reduction and internal fixation was associated with high complication rates and did not result in significantly improved outcomes. In the last decade, operative management of calcaneal fracture is increasingly preferred over conservative management. The objective of this thesis is to get conclusion which will be useful in selecting treatment in particular case to get maximum good results and improved outcomes.
Aim: To study outcome evaluation of calcaneus fractures treated by conservative and surgical treatment according to AOFAS scoring system.
Materials and Methods: This study was conducted at our institute during the period of February 2014 to November 2015. All patients with displaced intraarticular calcaneum fracture meeting with the inclusion criteria were included in the study. All patients were treated either with conservative or surgical modality. Patients were regularly followed up at every 2 month thereafter. At each visit patients were physically examined regarding the condition of scar, any sign of infection, heel width, subtalar and ankle movement and any other possible complications. Radiological assessment was done for union and subtalar arthritis as well as Bohler and Gissane angle were also measured at each follow up. At final follow up visit patient were also asked about change in occupation and change in shoe size. At final follow up patient functional assessment was done using AOFAS score.
Results and Discussion: In our study for conservative group, excellent as well as good results were found in 31% cases. Unlike, the similar study carried out by Kulkarni et al. who found that 66% of cases were in category of excellent as well as good and the similar study carried out by K S leung et al. 60 found that 53% cases were in category of excellent as well as good. In our study for operative group, excellent as well as good results were found in 40% cases. Unlike, the similar study carried out by Kulkarni et al., who found that 80% of cases were in category of excellent as well as good and the similar study carried out by K S leung et al. who found that 91% cases were in category of excellent as well as good. For percutaneous group, 34% of cases had score in the category of excellent as well as good which was nearly similar to study conducted by Tim scheper et al.
Conclusion: In the present case study of 42 patients after evaluation of functional and radiological outcomes of various modalities of treatment by AOFAS Scoring system, it was concluded that the operative management in case of joint depression type calcaneum fracture yields overall better functional outcome compared to conservative treatment. The overall complication rate was almost comparable in conservative as well as operative group. Finally, a larger study with longer follow-up is required to make definitive recommendations.