Prognostic Value of Four Classifications of Calcaneal Fractures

Background: The purpose of this study was to assist surgeons treating calcaneal fractures in choosing the most predictive fracture classification and clinical outcome tool. Materials and Methods: For 152 patients (189 calcaneal fractures; average followup, 9.9 years), all fractures were classified in accordance with the Essex-Lopresti, OTA, Regazzoni, and Sanders classifications and matched with the following scores: AOFAS score, CNHF, FOA, MFS, Rowe, MFA, SF-36, and VAS. Results: The Essex-Lopresti classification showed no statistically significant relation with any of the clinical scores (p > 0.05). The OTA classification related statistically significant with the MFS (p = 0.006), AOFAS score (p = 0.013), FOA (p = 0.019), Rowe (p = 0.0027), and MFA score (p = 0.03). The Regazzoni classification correlated with the AOFAS score (p = 0.003), MFS (p = 0.002), Rowe (P 0.002), CNHF (p = 0.0001), FOA (p = 0.003), MFA score (p 0.002), and VAS (p = 0.005). The Sanders classification correlated with the AOFAS score (p = 0.007), MFS (P = 0.001), Rowe (p = 0.001), CNHF (p = 0.024), FOA (p = 0.021), MFA score (p = 0.036), and VAS (p = 0.014). Conclusion: Compared to radiological based classifications, the CT based classifications, especially the Regazzoni Hod Sanders classifications, exhibited higher prognostic value compared to ultimate outcome scores.