Early Full Weight-Bearing After Calcaneal Fracture Using a Heel-Unloader Orthosis: Equivalent Radiographic Outcomes...

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomechanics

Background:

• Standard calcaneal fracture treatment involves prolonged immobilization, leading to risks like ankle stiffness and deconditioning.
• The heel-unloader device facilitates early full weight-bearing by load redistribution, potentially mitigating these risks.

Purpose of the Study:

• To compare radiologic and clinical outcomes of heel-unloader treatment versus conventional cast immobilization for calcaneal fractures.
• To assess the safety and efficacy of early mobilization using a heel-unloader.

Main Methods:

• Retrospective analysis of 101 calcaneal fractures treated with either cast immobilization or a heel-unloader.
• Primary endpoint: Böhler angle (BA) loss at 12 weeks. Secondary endpoints: pain, range of motion, complications, and degeneration.
• Equivalence of BA loss was statistically tested using two one-sided tests (TOST).

Main Results:

• No significant difference in mean Böhler angle loss between the heel-unloader (-4.7°) and cast (-3.8°) groups at 12 weeks, confirming equivalence (TOST P < .001).
• Similar distributions of operative vs. non-operative management between groups.
• No significant differences observed in secondary outcomes, including pain, motion, and complications.

Conclusions:

• Early full weight-bearing with a heel-unloader provides radiologically and clinically equivalent results to traditional casting for calcaneal fractures.
• The heel-unloader is a safe and effective alternative for facilitating early mobilization and potentially improving patient outcomes.