Title : Open excision of the Anterior Process of the Calcaneus (APC) for degan classification type II fracture non-union: A retrospective analysis of Patient-Reported Outcomes (PRO)
Abstract:
Background: Fractures of the Anterior Process of the Calcaneus (APC) are often misdiagnosed as ankle sprains. Some patients develop symptomatic non-union. There is limited evidence evaluating Patient-Reported Outcome Measures (PROMs) before and after excision of symptomatic non-union of Degan type II APC fractures. This study aims to determine if excision of the APC for symptomatic non-union Degan II fractures results in a clinically relevant improvement in patient reported outcomes.
Methods: We undertook a retrospective analysis of a single surgeon series of patients undergoing open excision of the APC between February 2021 and June 2024. Inclusion criteria were adults with symptomatic non-union of Degan type II APC fracture who had failed conservative management for at least 6 months and completion of pre- and post- operative European Foot and Ankle Society (EFAS) score, EQ-5D index, and Manchester- Oxford Foot Questionnaire (MOXFQ).
Results: Six patients underwent surgery. Five completed pre- and post-operative PROMs and were included for analysis. Mean follow-up was 29.4 months (range 12–56). The mean EFAS improved from 7 to 15.2 (p = 0.00037). EQ-5D index improved from 0.632 to 0.809 (p = 0.0501). All MOXFQ domains improved: Pain decreased from 72 to 29 (p = 0.0231), Standing from 69.2 to 24.4 (p = 0.0160), and Social from 43.8 to 14 (p = 0.0313). The mean change exceeded the minimal clinical important difference (MCID) in EQ-5D index and all MOXFQ domains. There is no MCID stated for EFAS. No post-operative complications were reported.
Conclusions: Open excision of symptomatic non-union of Degan type II APC fractures demonstrated statistically significant and clinically relevant improvement in patient reported functional outcomes. Based on our findings operative management should be considered for patients suffering from pain and discomfort secondary to non-union of APC fractures when a trial of conservative management has failed.
