ANALYSIS OF MORPHOLOGY AND GAIT FUNCTION AFTER INTRAARTICULAR CALCANEAL FRACTURE

Open reduction and internal fixation is suggested by an increasing num ber of investigators as preferable treatment of displaced intraarticul ar calcaneal fractures. Assuming that quasianatomical reduction coinci des with adequate function, many surgeons rely on morphological parame ters (standard radiography, computed tomography) to demonstrate the ef fectiveness of surgery by achieving an optimum restoration of calcanea l geometry and joint surfaces. In order to correlate morphologic param eters and functional assessment, a prospective study was performed on 45 patients after surgical treatment of intraarticular calcaneal fract ures using standard radiographic and computed tomographic scores, clin ical evaluation, and gait analysis (dynamic pedography). Mean follow-u p time after reconstruction was 23 months (range 18-50). Although clin ical evaluation and assessment of gait function corresponded well with each other, radiographic scores showed a poor to moderate correlation with functional evaluation (r = 0.29-0.62); this was probably due to the missing analysis of soft tissue parameters. The comparison of clin ical results and gait parameters with the individual radiographical pa rameters allowed us to identify those factors, with the greatest influ ence seen on the functional prognosis (i.e., calcaneal width, arthrosi s in the neighboring joints). Morphologic analysis after calcaneal rec onstruction based on radiographic techniques cannot predict subsequent function or substitute for functional assessment. However, it does al low for practical conclusions for surgical strategy in primary osseous reconstruction or secondary corrections.