The epidemiology of calcaneal fractures requiring operative fixation: our 10 years’ experience

O. Salar, F. Shivji, J. Holley, B. Choudhry, A. Taylor, C.G. Moran

Introduction: Calcaneal fractures are rare but debilitating injuries assumed to affect particular demographic sub groups. This study aimed to relate epidemiological factors (age, gender, smoking status and social deprivation scores) to the incidence of calcaneal fractures requiring operative fixation over a 10-year period.

Methods: Data (age, gender and smoking status) was extracted from a prospective trauma database regarding calcaneal fractures between September 2002 and September 2012. The Rank of Index of Multiple Deprivation (IMD) scores was collated for each patient and data sub-stratified in 20% centiles. 2010 National Census Data was used to formulate patient subgroups and incidences. Resulting data was subjected to statistical analysis through calculation of relative risk (RR) scores with 95% confidence intervals (95% CI).

Results: 101 calcaneal fractures in 95 patients that underwent operative fixation were identified. 3 open fractures in 3 patients were excluded. In males, the annual incidence of calcaneal fractures requiring operative fixation was 5.10 per 100,000 compared to 1.25 per 100,000 in females (RR 1.60, 95% CI 1.45-1.77). The mean age in males was 36.8 years with a peak incidence between 20-29 years old. The mean age of females was 42.5 years with a peak incidence between 30-39 years old. In females, there was a more even spread throughout all ages with a gradual increase in incidence towards post-menopausal ages. 54 (55.1%) fractures requiring operative fixation occurred in smokers compared to 44 (44.9%) in non-smokers, (RR 2.00, 95% CI 1.39-2.88). Rank of IMD scores revealed 34.0 % of all fractures occurred in the top 20% (RR 1.7, 95% CI 1.28- 2.26) most deprived areas and 58.5% of fractures in the top 40% most deprived areas.

Conclusions: This study indicates that male gender, smoking status and high rank of multiple deprivation scores are independent characteristics associated with calcaneal fractures requiring operative fixation.