American Fellowship-Trained Foot & Ankle and Trauma Surgeons Fix the Majority of Calcaneal Fractures in the First Years of Independent Practice

Background: Calcaneal fractures are among the most challenging foot injuries managed by orthopaedic surgeons. Given their high technical demand and inherent complication profile, calcaneal fractures are often, but not always, referred to subspecialists with fellowship training in either Foot and Ankle (FA) or Trauma surgery. The primary purpose of this study was to evaluate practice trends and to determine whether calcaneal fracture ORIF volume and early complication rates differ among early-career American orthopaedic surgeons (typically within their first 1-2 years of practice) by fellowship training type. Methods: The American Board of Orthopaedic Surgery (ABOS) Part II database was used to identify all calcaneal fracture open reduction internal fixation (ORIF) cases performed from 2003 to 2019. Candidates were grouped by fellowship training. The percentage of surgeons performing calcaneal fracture surgery and the average number of cases performed per surgeon were analyzed using linear regression; odds of early complications were estimated using multivariable logistic regression. Results: A total of 3809 calcaneal fractures were surgically managed by 1624 early-career orthopaedic surgeons from 2003 to 2019. FA surgeons comprised the largest proportion (35.0%) and performed the greatest number of these cases (42.5%). They were closely followed by Trauma (29.6%), who performed 35.6% of the reported calcaneal fracture ORIF cases. Of all early-career FA and Trauma fellowship-trained surgeons, 72.4% and 55.1% performed calcaneus surgery, respectively. The number of cases performed significantly decreased by 0.05 cases per year over the 17-year study period. The number of cases performed on patients aged ≥50 years increased by 0.024 cases per year per surgeon. Fellowship-trained FA or Trauma surgeons had 37% higher odds of reporting an early complication compared with generalists (OR = 1.37; 95% CI, 1.04-1.80; P = .027). Conclusion: This study identified trends in the surgical management of calcaneal fractures over the last 2 decades. These findings may inform fellowship selection and training curriculum. Level of Evidence: Level III, retrospective case review.