Comparison of Functional Result
and Prognostic Factors of Unilateral
and Bilateral Calcaneal Fracture
Sunghwan Byun, DPM, PGY-4
St. Luke’s Hospital, Allentown, PA
Sangbong Ko, MD
Department of Orthopedic / Daegu Catholic University
Daegu / South Korea
Sangwook Lee, MD
Department of Orthopedic / Daegu Catholic University
Daegu / South Korea
Disclosure
<Comparison of Functional Result and Prognostic Factors of Unilateral and>
Bilateral Calcaneal Fracture
<Sunghwan Byun, DPM ; Sangbong Ko, MD ; Sangwook Lee, MD >
My disclosure is in the Final AOFAS Program Book. I have no potential
conflicts with this presentation.
Introduction
• Calcaneus Fracture
 2% of all Fractures ( 65% of Tarsal bone Fracture )
 Complex Anatomy and Uncertain prognosis
 Bilateral Calcaneus Fracture – Rare
• Purpose
 Subject and Object Evaluation of Patients
 Prognostic Factors of Bilateral Calcaneus Fracture
 Compare the Prognosis between Unilateral and Bilateral Calcaneus Fracture
Material & Methods
Inclusion & Exclusion Criteria
From March 1985 to July 2008
32 Cases among 298 Cases
Age
Exclusion Criteria
1. Bilateral
1. Past Surgical History
on Calcaneus
2. Secondary Gain
3. < 18 year old and
60 year old >
2. Operation Indication
Even Unilateral
Sex and Age
Sex
Inclusion Criteria
Male (63)
Female (32)
38.34 ± 9.47 ( 18 – 59 ) year
3. At least 1 ⅟₂ year
follow up
Etiology
Fall Down
31 ( 97 % )
MVA
1 ( 3% )
Material & Methods
Treatment protocol
Within 2 weeks
Approach
 Lateral Approach ( by Palmer ) – Extensile
Lateral Approach ( by Benirsche)
Closed Reduction / Percutaneous Pinning
ORIF with Recon. Plate and Screw
Below Knee Cast ( 6 weeks )
Postop Evaluation
Radiographic : Böehler Angle
(Preop, Postop 4 – 6 weeks, last follow up)
Clinical : OPD Visit & Telephone Interview
Material & Methods
CFSS ( Calcaneus Fracture Scoring System ) (by
P.K Kerr et. Al.) 13
•
•
Table
Calcaneus Fracture Scoring System / CFSS
Pain(36 point)
Others

Creighton – Nebraska Health Foundation Score

Maryland Foot Score
Small Sample Size – Not Normal Distribution
Work(25 point)
- Nonparametric Rank Test
•
Linear Correlation
•
Retrospective Study
Statistical Study
•
SPSS Version 9.0
•
p < 0.005
Walking
( 25
point )
Walking aids
( 14 point )
At rest
None
Slight
Moderate
Severe
On activity
None
Slight
Moderate
Severe
No change in job
Modification of job
Enforced change of job
Unable to work
No change in walking ability
Minimal restriction
Moderate restriction
Severe restriction
None
Occasional stick
Constant stick
2 sticks
Crutches
Table 1. The proposed calcaneal fracture scoring system
18
12
6
0
18
12
6
0
25
16
8
0
25
16
8
0
14
10
6
3
0
Results
CFSS /VAS
Bilateral
Unilateral
p - Value
CFSS
82.66±16.8
1(34-100)
80.09±17.3
1(24-100)
p = 0.479
VAS
2.94±2.02
3.56±2.29
p = 0.185
Sex
CFSS
Male
Female
P Value
Bilateral
86.238 ±
2.526
75.357 ±
6.683
P = 0.535
Unilateral
81.62 ±
15.98
73.21 ±
21.69
p value
p = 0.081
p =0.973
Body Weight & CFSS
Bilateral
Unilateral
( p = 0.096 )
( p = 0.780 )
p : probability
Age & CFSS
Bilateral
Unilateral
(p = 0.399)
(p = 0.119)
p : Probability
Result
Smoking
Associate Injury
CFSS
Smoking
NonSmoking
p value
CFSS
Associate
Not
Associate
p value
Bilateral
80.06 ±
18.69
85.60 ±
14.44
p = 0.360
Bilateral
74.46 ±
22.01
88.26 ± 9.03
*p = 0.02
Unilateral
81.34 ±
17.42
78.13 ±
17.24
p = 0.431
Unilateral
75.19 ±
18.35
84.63 ± 15.14
*p = 0.016
p value
p = 0.800
p = 0.157
p value
p = 0.553
p = 0.807
Conclusion
• This study shows the prognosis of both unilateral and bilateral calcaneal
fracture are not correlated with factors such as smoking, age, sex and body
weight
• The statistical study shows that there is no difference in prognosis between
unilateral and bilateral calcaneus fracture.
• Both unilateral and bilateral fracture have poor prognosis via statistical study
when the injury is combined with other lower extremity fracture.
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