Review Question - QID 1268

The patient most likely to require late subtalar fusion for post-traumatic arthritis is a male patient with a Sanders Type III fracture treated with ORIF.

The Sanders classification system seems to remain prognostic for injury severity. It has been shown that greater articular injury is associated with greater risk of arthritis, irrespective of patient gender and occupation. In current reviews, type III fractures are 6.5 times more likely to develop PTA and 4 times more likely to require an ST fusion than Sanders type II fractures. Post-traumatic arthritis of the subtalar joint is a common complication. Successful salvage can be achieved with a subtalar arthrodesis.

Howard et al reported on complications following management of displaced intra-articular calcaneal fractures. 469 patients were randomized into ORIF and non-operative groups. ORIF patients were more likely to develop complications (overall 25% vs 18% of non-op) with fractures of increasing severity (Sanders IV) developing more complications regardless of management strategy.

Sanders et al. reviewed the operative treatment of displaced intra-articular calcaneal fractures. Based on the results of this comparative analysis, the Sanders classification remains prognostic; after a minimum of 10 years, type III fractures were 4 times more likely to need a fusion than type II fractures.

Illustration A shows the Sanders classification.

Incorrect Answers:
Answers 1,3-5: Functional outcomes and arthritis will be determined by the amount of cartilage damage. This is directly correlated with initial injury, fracture pattern (Sanders) and reduction techniques. Worker compensation are associated with worse functional outcome scores, not post-traumatic arthritis.