Calcaneal fracture epidemiology and fixation trends in England, 2000 to 2017

J.A. Humphrey, A. Woods, A.H.N. Robinson

Background: The primary aim is to document the epidemiology of admitted calcaneal fractures in England since the year 2000 in adults (age >18 years). The secondary aims are to determine whether the UK Heel Fracture Trial (UK HeFT) has impacted on the proportion of admitted calcaneal fractures being surgically fixed and whether there has been any change in the surgical technique used.

Methods: In England the Hospital Episode Statistics (HES) data is recorded annually. Between 2000/01 and 2016/17 the number of adults admitted to an English NHS hospital with a diagnosis of a calcaneal fracture and whether they were treated with surgical fixation was determined.

Results: Over the 17-year period 62,858 patients were admitted to hospital with a calcaneal fracture. The male to female ratio was 2.66:1. The mean annual incidence for males is 10.5 / 100,000 and for females 3.8 / 100,000. UK HeFT was published in July 2014. The percentage of patients with an admitted calcaneal fracture undergoing internal fixation pre-publication was 7.31% (3,792/51,859). Post-publication the internal fixation rate was 7.38% (534/7,229), which was not significantly different (p=0.94). Nevertheless of those calcaneal fractures that were internally fixed there has been a significant increase (p=< 0.001) in the percentage treated by closed reduction as opposed to open reduction subsequent to the publication of UK HeFT, from 8.32% (292/3511) pre-publication to 13.29% (71/534) post-publication.

Conclusion: This study documents the epidemiology and fixation trends of calcaneal fractures in England. We have established that surgeons did not change their clinical practice in terms of offering surgery for calcaneal fractures in response to UK HeFT. Surgeons though continue to innovate to find better ways of surgically treating calcaneal fractures, with a recent increase in less invasive procedures.