Calcaneal fracture: results of earlier rehabilitation after open reduction and internal fixation

Abstract

Introduction This study aimed to analyze the clinical and radiological outcomes of early weight-bearing and rehabilitation after open reduction and internal fixation (OR/IF) of calcaneal fracture. Materials and methods This retrospective study was conducted on 78 patients with unilateral calcaneal fracture who underwent OR/IF. A mean follow-up period was 45.8 months (range 12-135). Two weeks after surgery, the range of motion (ROM) exercise was started, brace or heel off shoe was applied, and forefoot weight-bearing was allowed. Four weeks after surgery, tolerable weight-bearing ambulation without crutch was allowed. When the patient was not walking, the braces were removed to perform peritalar ROM exercises. Radiologic evaluation was performed by measuring the Bohler angle and incongruency of the subtalar joint surface. Paley grade was used to assess traumatic arthritis. Clinical evaluation was performed by measuring the foot and ankle outcome score (FAOS) and ankle ROM. Results The mean postoperative Bohler angle was 31.7 degrees (P < 0.001) at 2 weeks, 31.2 degrees at 3 months, and 30.1 degrees at the last (P = 0.4). The average Paley grade of the subtalar OA was 1.12. CT imaging revealed that the average step-off of the subtalar joint was 1.26 mm in coronal and 0.84 mm in sagittal. The average ROM results were as follows (contralateral, affected side): there was no significant difference in dorsiflexion [16.9 degrees vs. 16 degrees (P = 0.6)], whereas plantarflexion and inversion were significantly decreased [39.5 degrees vs. 35.3 degrees (P = 0.049) and 50.5 degrees vs. 34.8 degrees (P = 0.04)]. The average FAOS score was 86.1 points, and the highest score was "function" (mean 92.5 points). Conclusions Earlier rehabilitation after OR/IF is recommended for the treatment of calcaneal fracture.