The Association Between Subtalar Joint Motion and Outcome Satisfaction in Patients with Displaced Intraarticular Calcaneal Fractures

Abstract

There is a paucity of literature on the effect of calcaneal fractures on subtalar joint motion and patient satisfaction. The objective of this study was to determine the relationship between subtalar joint motion and outcome satisfaction in patients who had displaced intraarticular calcaneal fractures. The design of this study was a retrospective analysis from a randomized, controlled clinical trial. The setting was a Level I trauma center. Of the 332 displaced intraarticular calcaneal fractures entered into the clinical trial and managed by the senior author, 244 fractures had subtalar joint motion measurements taken at least 12 weeks after fracture, and patient-oriented outcomes were reviewed at 2 years. Nonoperative treatment consisted of ice, elevation, and rest without closed reduction. In the operative group, an extended lateral approach was used with subchondral fixation, plating, and bone grafting when necessary. The Short Form 36 (SF-36), a validated visual analogue scale (VAS), and a gait analogue score measured patient satisfaction. Subtalar joint motion was recorded as percentages of the uninjured limb and grouped into quartiles. The VAS, SF-36 (p <.0001), and the gait satisfaction score (p <.05) all increased significantly with increasing subtalar joint motion. Satisfaction on the VAS and SF-36 was significantly related to subtalar joint motion for men (p <.0001) and in the age groups 30 to 39 (p <.001) and 40 to 49 years (p <0.05). In non-Workman Compensation Board (WCB) clients, higher subtalar joint motion was significantly related to improved satisfaction on VAS and SF-36 (p <.005). Patient satisfaction was significantly related to subtalar joint motion as measured by the VAS when patients reported pre-injury workloads of moderate (p <.05) or heavy (p <.01) regardless of whether they were treated operatively (p <.05) or nonoperatively (p <.0005). The amount of subtalar joint motion at least 12 weeks after displaced intraarticular calcaneal fracture is significantly related to patient satisfaction at 2 years regardless of the method of treatment.