• F K Massen, S F Baumbach, V Herterich, W Böcker, H Waizy, and H Polzer.
• University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany. Electronic address: felix.massen@med.uni-muenchen.de.
• Injury. 2019 Oct 1; 50 (10): 1781-1786.

BackgroundFractures to the anterior process of the calcaneus (APC) have long been considered rare injuries. Although recent studies have reported a higher incidence, these injuries have yet received little attention in clinical research. Only few case reports/series, all suffering multiple methodical shortcomings, exist. The aim of this study was to objectively evaluate the outcome after fractures to the APC treated by full weight bearing and to investigate the influence of fracture characteristics.MethodsRetrospective register study with prospective follow-up. Adults with acute unilateral fractures to the APC and concomitant injuries limited to the Chopart joint line, treated by full weight-bearing, with a follow-up of ≥ 12 months were included. Fracture characteristics (Degan classification, displacement, intra-articular involvement, comminution) were assessed in CT scans. Return to work (RTW) / sports (RTS), Visual Analogue Scale Foot and Ankle (VAS-FA), Karlsson Score and the 12-Item Short-Form Health Survey (SF-12) were assessed. The influence of age, sex, fracture type/characteristics, and concomitant injuries on the outcome parameters was analyzed.Results27 patients (38 years, IQR 29-58), 74% female with a median follow up of 24 months (IQR 16-41) were included. 56% of the fractures were non-displaced and 82% comminuted. 48% were type I, 33% type II and 19% type III according to Degan. 78% of the patients suffered concomitant injuries of the Chopart joint line. Median RTW was 14 days (IQR 10-42), and RTS 90 days (IQR 30-180). The clinical outcome resulted in a median overall VAS-FA of 95 (IQR 89-98), Karlsson Score of 90 (IQR 82-100) and SF-12 PCS of 56 (IQR 53-58) / SF-12 MCS 55 (48-58).ConclusionFunctional treatment of fractures to the anterior process of the calcaneus yielded good to excellent results and a fast return to work in the vast majority of patients. Yet, a prolonged return to sports was noted. No significant differences regarding the outcome were observed when comparing the different fracture types or any other fracture characteristic assessed.Copyright © 2019 Elsevier Ltd. All rights reserved.

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