Objectives: To determine which demographic variables are linked with outcome in displaced intraarticular calcaneal fractures. The variables studied were age, gender, work capability, Workers' Compensation Board (WCB) support, and injury type.
Design: A prospective cohort study with a minimum of two years of follow-up.
Setting: A university-affiliated Level I trauma hospital.
Patients: One hundred sixty-nine patients who required treatment for displaced intraarticular calcaneal fractures treated by a single surgeon. To be included in the study, patients had to be aged between fifteen and sixty-five years at the time of the injury, have closed injuries, and have posterior facet displacement greater than two millimeters.
Intervention: Patients were treated nonoperatively or operatively, using a lateral approach to the calcaneus.
Main outcome measurements: Outcome was measured by return of patients to full-time work, change in work capability after treatment, the SF-36 health survey, and visual analog scales.
Results: Male gender, medium and heavy labor, presence of WCB support, and presence of bilateral intraarticular fractures all proved to be associated with a poorer prognosis. Female patients did well when treated nonoperatively and operatively, whereas male patients always were less able to return to work at the same level as before the injury. Operatively treated patients returned to work quicker (average, eighty-seven days).
Conclusions: Males, multiply injured patients, and heavy laborers may have better outcomes with operative treatment, whereas females and non-WCB patients may do better with nonoperative treatment.