Calcaneal fractures: A trauma system wide evaluation of patient, injury and fracture characteristics and their association with patient-reported outcome measurement

Abstract

Introduction Calcaneal fractures are known to cause a considerable long-term disability. Health-related quality of life (HRQoL) in general is influenced by various patient-specific factors, and possibly trauma and fracture characteristics. Previous studies might have underestimated the impact of this injury because of several injury and patient specific exclusion criteria. Knowledge on patient, injury and fracture characteristics and patient-reported outcomes are needed, to improve the outcome in these patients. In this study we evaluate the characteristics and their association with several patient-reported outcome measurements. Material and Methods This is a trauma system wide retrospective regional cohort study of prospectively collected data. All patients aged 16 years or older with a calcaneal fracture admitted in one of the participating trauma level I or II hospitals were included. Patients’, trauma and fracture characteristics were collected. Moreover, we evaluated current health status with a questionnaire. We have used the EQ-6D for quantification of the HRQoL. Moreover, several patient-reported outcomes were evaluated, for example capability to work and satisfaction with wearable range of shoes. Results A fall from height was the mechanism of trauma in most patients, followed by a simple fall. The vast majority of the accidents occurred in domestic circumstances. Seventy percent of the patients had an isolated calcaneal fracture. The trauma level I population was significantly younger, sustained a more severe injury with more concomitant injuries, and 26% had a psychiatric history. Moreover, the presented studies demonstrate that all dimensions of the EQ-6D are affected; in particular the dimensions ‘mobility’, ‘pain / discomfort’ and ‘usual activity’. After the injury, 85% is capable to work. Conclusions This thesis demonstrates that patients who endured a calcaneal fracture have a lower HRQoL than the general population; implicating that these patients had a life-altering event that resulted in chronic disabilities. Also, this thesis reveals fracture characteristics that are associated with patient-reported outcomes that may be used to inform patients early and more accurately.