Functional outcomes of primary subtalar arthrodesis versus nonoperative treatment followed by late calcaneoplasty and subtalar arthrodesis in sanders type IV calcaneal fractures, a prospective cohort study

Background Primary subtalar arthrodesis (STA) or nonoperative treatment followed by late STA are both valid options in treating Sanders IV calcaneal fractures with no studies comparing them. Methods 34 patients with Sanders IV calcaneal fractures were included. 17 patients were managed by open reduction and primary STA, while the others had late calcaneoplasty and STA. Outcomes were measured by American Orthopaedic Foot and Ankle Society’s Ankle-Hindfoot scale (AOFAS-AHS) and Foot and Ankle Ability Measure - Activities of Daily Living (FAAM-ADL). We also documented time to return to work (RTW), union rate, wound complications and second surgeries. Results 29 patients were followed for at least two years. At final follow-up, the mean American Orthopaedic Foot and Ankle Society’s Ankle-Hindfoot scale and Foot and Ankle Ability Measure - Activities of Daily Living were slightly better in primary STA. The time to return to work was significantly shorter in primary STA with comparable union rate, wound complications and second surgeries. Conclusion Primary STA reduces the disability time of these severe fractures. Level of evidence Level II