足と足首の臨床研究

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A Trauma System wide Evaluation of the Demographic, Injury and FractureCharacteristics of Patients with Calcaneal Fractures: A Comparison of Trauma Level I and II Centers

Alexandridis G, Gunning AC, van Olden GDJ, Verleisdonk EJMM, Segers MJM, Leenen LPH

Introduction: Calcaneal fractures are known to influence patients daily lives negatively. Different levels of trauma centers face a diversity of patients who sustained a calcaneal fracture. Little is known about the demographic, trauma and fracture characteristics for these patients. Moreover, the differences in these characteristics between different levels of trauma care. Knowledge of this is needed, to improve the outcome in these patients. In this study we evaluate in detail the characteristics of patients with a calcaneal fractures in a regional inclusive trauma system.
Material and Methods: This is a 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.
Results: A total of 285 patients with 307 calcaneal fractures were eligible for analysis. A mechanism of trauma was in most patients a fall from height, followed by a simple fall. The greater majority of the accidents occurred in domestic circumstances, 70% of the patients had an isolated calcaneal fracture. The trauma level I population (n= 72) was significantly younger, sustained a more severe injury with more concomitant injuries, and 26% had a psychiatric history.
Conclusion: This study demonstrates, that there are substantial differences between the level I and II trauma centers in the demographic patterns and injury characteristics in patients with a calcaneal fracture. These differences should be accounted for in the interpretation of results according to the level of trauma care that a particular hospital offers. Additionally, in the trauma level II centers more low-complex calcaneal fractures and distinctively other subgroups (e.g. elderly) are admitted that might benefit from customized management to adapt to their specific needs.