The epidemiology of calcaneal fractures

Calcaneal fractures are rare, but debilitating injuries, which occur frequently in younger individuals. The economic impact of the residual long-term disability that may occur after these injuries is therefore disproportionate to their incidence. The aim of this study was to review the epidemiology and injury patterns of this injury.

Data was extracted from a computer database, which prospectively coded all orthopaedic trauma events in a single unit between January 1995 and June 2005. Over this period 697 patients sustaining 752 fractures (55 bilateral) were treated in our unit. The patient's demographic details were prospectively recorded, together with details of their injury and primary treatment. The radiographs of a subgroup of patients were retrospectively examined in detail.

The annual incidence of fracture was 11.5 per 100,000, and occurred 2.4 times more frequently in males than females. In males, the incidence was 16.5/100,000/year, with a peak incidence in the age range 20-29 (21.6/100,000/year). In females, the overall incidence was 6.26/100,000/year, with a more even spread throughout the age cohorts and showing a gradual increase in incidence towards the post-menopausal years. The majority of fractures were sustained in falls from a height (71.5%), and 64.3% of these were from 6 feet and above. Only 18.8% of fractures occurred in the workplace, and although manual workers made up the largest occupational group, significant numbers occurred in both unemployed and the retired. Most injuries occurred in isolation but the most commonly seen concomitant injuries were lower limb (13.2%) or spinal injuries (6.3%). Conventional radiography in a subgroup of the patients showed an average Böhler's angle of 16.5 degrees with no difference between the males and females. There was a strong association between the severity of the fracture, as assessed using the Sanders classification on computerised tomography, and the degree of depression of the Böhler's angle (p=0.002).