Calcaneus fractures, epidemiology and treatment - Data on 3 949 fractures from the Swedish Fracture Register.

BACKGROUND

Due to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment.

METHODS

The study is based on data from the Swedish Fracture Register and include patients ≥ 18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n = 320, could be identified and were studied in a separate analysis.

RESULTS

The study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60 %) were men. Fall from height was the most common mechanism of injury (n = 1683; 46 %) and high-energy trauma was documented in 887(28 %) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n = 1105; 89 %) and B (n = 717; 93 %) fractures were treated non-surgically, while surgical treatment was more common in type C (n = 499; 43 %) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used. Of the patients with bilateral fractures 80 % were male, (n = 128). They were generally younger (mean age of 38 years (SD±14.5, p < 0001) and had a larger proportion of high-energy traumas, n = 107 (67 %) compared with patients with unilateral fractures.

CONCLUSION

Calcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically.

LEVEL OF EVIDENCE: IV, retrospective observational cohort study.