[Difficulties in evaluating follow-up outcome in calcaneus fracture managed with plate osteosynthesis. Is there a reliable score?]

A huge amount of publications is existing dealing with topics of operative or nonoperative treatment, results and follow-up of fractures of the os calcis. Comparing the different studies one can see that there are a lot of different scores applicated for follow-up and outcome. Therefore it's difficult or impossible to compare the results of the different publications. The problems are discussed while evaluating own results of operative treated fractures of the os calcis. Between 1993 and 1996 we treated 27 fractures with ORIF (open reduction and internal fixation). 25 of the patients could be followed-up after a mean of 22.1 months. For follow-up three recently published scores, the AOFAS Ankle-Hindfoot Scale (AOFAS), the Calcaneal Fractures Scoring System (CFSS) according to Kerr and the Functional Outcome Assessment-Score (FOA) according to Thordarson were used. The mean AOFAS-Score was 76.52 +/- 14.22, the mean CFSS was 77.40 +/- 15.22 and the mean FOA was 70.08 +/- 18.53 points. The differences between the AOFAS and the FOA-Score were significant (p = 0.017). The differences between the CFSS and the FOA-Score were significant (p = 0.004), too. These different values elucidate the need of uniform structured follow-ups of fractures of the os calcis. To compare different national or international studies uniform scores should be used. In anglo-american literature the AOFAS Ankle-Hindfoot Scale is well established. This scoring-system proved to be quite useful in our own analysis. We suggest that the AOFAS Ankle-Hindfoot Scale also should be taken into account in german literature, especially in follow-up of calcaneal fractures.