Calcaneal Fractures: Epidemiology, Postoperative Complication and Evaluated Böhler and Gissane Angle in 202 Patients - A Retrospective Danish Single Centre Cohort

Background: Calcaneus fractures are known to be difficult and challenging traumatic conditions, the surgical treatment aims to restore normal anatomy and joint line congruency, however, this is with a high risk of infections and complicated wound healing. This study aims to evaluate the outcome of 202 patients with severe calcaneus fractures due to trauma, from 2012 – 2016 in a single centre study (Rigshospitalet, Denmark).  Material and methods: A retrospective single-centre cohort study including 202 patients with 221 calcaneus fractures (19 patients had bilateral fractures) due to trauma, between 2012 - 2016. Surgical treatment for intraarticular fractures has at the beginning of the study been performed with a J/L shaped approach but during the study period, a change to a more minimal technique with the sinus tarsi approach was made. Patients were identified from surgery board and medical coding and in a retrospective study design evaluation at 8 weeks, 26 weeks and 52 weeks postoperatively were obtained from medical records.Two experienced orthopaedic surgeons measured the Böhler and Gissane angles on conventional X-rays on the lateral view.  Results: In total, 221 calcaneal fractures were recorded during this study, 19 patients had bilateral calcaneal fractures and 217 were treated surgically. Intraarticular fractures (n=181) constitute 83% and extraarticular fractures (n=36) 17% of total. Twelve patients had an open injury (6%), 58 (27%) patients had other injuries related to the trauma (upper extremity n=12, lower extremity n=22, internal organs n=9, spine n=16, head n=2 and pelvic n=2), five of them with multi-trauma. Mean Böhler angle preoperative was 9.4 degrees (range: -20 ; 40) and mean postoperative angle was 27.7 degrees (range: 10 ; 45) with a significant improvement (p<0.001). Mean Gissane angle preoperative was 107.4 degrees (range: 52 ; 147) and mean postoperative angle was 124.1 (range: 102 ; 147) with a significant improvement (p<0.001).  Conclusion: We can conclude that a significant improvement of Böhler and Gissane angle are observed and soft-tissue complication still constitutes a major complication postoperatively.