Primary Subtalar Arthrodesis for Calcaneal Fractures to Optimize Performance: A Randomized Clinical Trial
Abstract
Management of severe injuries to the heel (displaced intra-articular calcaneus fractures) continues to be a major challenge for orthopedic surgeons. Previous studies have demonstrated poor outcomes, and results show that patients experience long-term pain and decreased quality of life postoperatively. Poor outcomes are driven by pain, in particular, which is linked to post-traumatic subtalar arthritis. The proposed study addresses the FY22 PRORP Clinical Trial Award Focus Area of Retention: Return to Duty. The purpose of this study is to examine patient outcomes following calcaneus fractures treated with two different surgical procedures -- Open Reduction and Internal Fixation (ORIF) + Primary Subtalar Arthrodesis (PSTA) and ORIF alone -- to determine if one procedure gets patients back to work or active duty faster. Both ORIF and ORIF+PTSA are standard and commonly performed procedures to treat calcaneus fractures at any trauma center. Typically, ORIF is performed; if patients develop painful post-traumatic subtalar arthritis, then they receive subtalar arthrodesis. Previous studies have demonstrated potential benefit of using subtalar arthrodesis initially (PSTA); however, a rigorous randomized controlled trial is needed to provide high quality evidence. We propose a randomized clinical trial to compare two treatments for patients with displaced intra-articular calcaneus fractures: (1) ORIF + PSTA and (2) ORIF alone. The study will be conducted at civilian and military medical centers and will enroll patients undergoing operative treatment for displaced intra-articular calcaneus fractures. Shortening the recovery period by performing an immediate subtalar arthrodesis (ORIF+PSTA) will likely facilitate returning a greater proportion of service members to duty compared to ORIF and sequential arthrodesis for those high number who will develop symptomatic post-traumatic arthritis. Avoidance of even minor complications can have an impact on timely return to duty in high demand occupations like the United States military. Minor complications or increasing recovery time by even a few weeks can have a negative impact on retention on active duty. We know that orthopaedic injuries and the sequalae of their reconstruction are the number one drivers of disability and loss to duty among wounded Service Members.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310505
Entities
People
- Joseph Hsu
Organizations
- United States Army
- Wake Forest University