Calcaneocuboid joint involvement in calcaneal fractures

The reported incidence of calcaneocuboid joint (CCJ) involvement in calcaneal fractures varies considerably. It is largely unknown to what extent CCJ involvement accounts for outcome in these fractures. Therefore, the goal of this study was to analyze the incidence and effects of CCJ involvement in calcaneal fractures.

The clinical records of 106 patients, treated between 2000 and 2004, were reviewed for fracture classification, injury mechanism, surgical treatment, and complications. In a prospective cross-sectional study, 44 patients were assessed clinically (SF-36 American Orthopaedic Foot and Ankle Society score) and radiographically. Gait analysis was performed using dynamic pedography.

Sixty-eight percent of all fractures had involvement of the CCJ. Fractures with CCJ involvement were caused by a more severe injury than fractures without CCJ involvement (Mann-Whitney U test, p = 0.03); this is reflected by a strong association between CCJ involvement and fracture classification (Spearman, p < 0.006). Patients with involvement of the CCJ-especially those with a postoperative step in the CCJ-achieved a lower SF-36 score as well as a lower American Orthopaedic Foot and Ankle Society score than patients without CCJ involvement. CCJ involvement was associated with more difficulties in walking on rough surface (Spearman, p = 0.020). Limitations during gait were confirmed by dynamic pedography. Grading of posttraumatic osteoarthritis was associated with fracture classification (chi test p < 0.02) and quality of reduction (chi test p < 0.01).

These results indicate that calcaneal fractures with involvement of the CCJ are associated with more severe trauma and worse outcome. Thus, the CCJ should be given more credit during surgery and in our research efforts.