Calcaneal fractures in the industrial patient

A retrospective review was performed on industrial patients who sustained calcaneal fractures within the State of Idaho during the years 1992 to 1994, and these patients were insured by the Idaho State Insurance Fund. Of 48 calcaneal fractures that occurred during this period, 18 were non-displaced extra-articular fractures and 30 were displaced intra-articular fractures. An independent evaluator contacted each patient and performed chart reviews regarding the work history, period of time off work, and cost incurred with the injury. A total of 24 primary surgical procedures were performed on patients who sustained a displaced intra-articular calcaneal fracture and 31 secondary procedures were performed including wound debridement, hardware removal, skin grafting, and secondary subtalar fusion. For patients whose calcaneal fractures could be treated with non-operative care, the average time from injury until return to work was 18 weeks, and the average total cost of injury was $14,230. For patients whose calcaneal fractures required open reduction and internal fixation, the average time loss from work was 35 weeks, and the average total cost of injury was $31,004. Seven patients whose calcaneal fractures were initially treated with an open reduction, internal fixation later underwent a hindfoot arthrodesis. The average time off work for these patients was 69 weeks and the average total cost of injury was $65,384. Fractures were rated on postoperative radiographs according to the quality of their operative reduction. Fractures that were non-anatomically reduced had an increased tendency to require a subtalar fusion. Nine patients sustained other injuries associated with their calcaneal fracture and three patients sustained an open fracture. Both concurrent injuries and open fractures were associated with increased total cost and increased time off work. The total cost of injury was doubled as was time off work when an open reduction and internal fixation was followed later by a secondary subtalar arthrodesis.