Factors Affecting the Formation of Post-Traumatic Subtalar Arthritis Following the Intra-Articular Calcaneal Fracture

Abstract

Category: Hindfoot Introduction/Purpose: The present study was performed to prospectively follow up the arthritic changes of subtalar joint following the intra-articular calcaneal fractures in 38 patients. Methods: A total of 38 patients with intra-articular calcaneal fractures were prospectively studied with a mean follow-up as 17.4 months. Conventional fixations were performed in 27 patients by several surgeons. Arthroscopic-assisted reduction and internal fixations were performed in 11 patients by a single foot-ankle fellowship trained surgeon. Baseline data, including postoperatively radiographic alignment, arthritic changes, osteochondral lesion characteristics via modified Outerbridge classification and locations of lesions at calcaneal/talar side, and arthroscopic treatment procedures, were collected. Statistical analyses were performed to compare the prevalence and characteristics of the osteochondral lesions between the group with or without post-traumatic arthritic changes. Results: Based on the interpretation of radiographic parameters by a single foot-ankle fellowship trained surgeon, there were 8 patients (21.1%) showed the arthritic progression. Acceptable reduction (fracture step/gap < 2 mm) was found in 31 patients (81.6%) in overall. No significant difference of the quality of fracture reduction was found among the groups (none, mild, significant progression of arthritis). In subgroup analysis in patients with arthroscopic-assisted reduction and internal fixations, there was no significant difference of the prevalence of osteochondral lesions among the groups. Conclusion: The prevalence of post-traumatic subtalar arthritis was found in X-rays around one in 5 patients with the intra- articular calcaneal fractures in short-term follow-up. No definitive factors affecting arthritic changes were found in this study. Further investigation is needed to identify these factors in longer term of follow-up.