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CFOS predicts posttraumatic osteoarthritis and poorer functional outcomes after intra-articular calcaneal fractures with a 90% positive predictive value, outperforming traditional radiographic grading systems.
A newly developed calcaneal fracture outcome score (CFOS) is transforming how surgeons evaluate intra-articular calcaneal fractures, delivering a 90% positive predictive value (PPV) for poor postoperative outcomes. The multidimensional scoring system markedly outperforms traditional radiographic grading methods in predicting posttraumatic osteoarthritis, functional recovery, and patient-reported outcomes.
Accurate assessment of radiographic reduction quality remains fundamental to tackling intra-articular calcaneal fractures. However, existing radiographic parameters—such as isolated measurements of step-offs or angular deformities—often yield a limited, one-dimensional view of joint restoration. Moreover, many grading systems exhibit inconsistent correlation with patient-reported functional outcomes. To address this gap, researchers developed CFOS, a comprehensive model that integrates detailed postoperative imaging findings with patient-specific prognostic factors.
The study analyzed postoperative computed tomography (CT) scans of 80 surgically treated calcaneal fracture patients. The outcomes examined were residual step, gap, and angulation at the posterior facet and calcaneocuboid joint, along with Boehler’s angle, Sanders classification, Gissane’s angle, burden of comorbid conditions, and tobacco use status. Each variable underwent z-score normalization before being incorporated into a LASSO regression model employing five-fold cross-validation. Weighted coefficients were used to calculate an individualized CFOS for each patient.
Predictive performance was examined against validated patient-reported outcome measures, including the 12-item short form health survey physical component summary (SF-12 PCS) and the visual analogue scale–foot and ankle (VAS-FA). Higher CFOS grades were pronouncedly linked with worse clinical outcomes, including:
The composite model achieved a mean PPV of 90%, clearly outperforming conventional radiographic grading systems. By combining detailed CT-based joint assessment with systemic risk factors like smoking and comorbidity burden, CFOS yields a multidimensional and clinically intuitive framework for determining reduction quality. Unlike traditional grading methods, the score aligns imaging findings with functional outcomes and osteoarthritis risk, offering meaningful guidance for postoperative prognosis in orthopedic trauma and foot and ankle surgery.
Injury
Calcaneal fracture outcome score (CFOS): A novel outcome-based prognostic CT grading for calcaneal fracture reduction
Jan Siad El Barbari et al.
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