Questionnaire: Treatment of displaced calcaneal fractures in Germany
1.) Name of hospital or pseudonym: XXX
2.) Demographic data of the respondents:
Beds of hospital: XXX
Department specialization: XXX
Beds at institution : XXX
Employment key : XXX
Hospital level (ACS Trauma Centre Designation) : XXX
3.) Calcaneal fractures treated at institutions per year (n):
Under 5
510
1120
2140
Over 40
4.) Number of personally operated calcaneal fractures: XXX
5.) Surgeon`s age:
< 30
30 – 40
41 – 50
51 – 60
> 60
6.) Years in practice:
< 5
5 – 10
11 – 15
16 – 20
> 20
7.) Please cross where applicable:
Registrar
Consultant
Attending
Chief physician
8.) Have you done job shadowing or fellowships in one of the following:
Trauma
Foot surgery
Other
9.) Are you active in further education of colleagues
Yes
No
10.) When is surgery performed after patient admission in most cases?
Directly, also at night
Within 24 hours
A couple of days after detumescent techniques (2 – 4 days)
A couple of days after detumescent techniques (5 – 9 days)
A couple of days after detumescent techniques (10 – 15 days)
A couple of days after detumescent techniques (over 15 days)
11.) Preoperative immobilization is done by:
Plaster cast
External fixator
Without fixation
12.) Classification of calcaneal fractures:
With the help of x-ray according to the Essex-Lopresti classification
With the help of x-ray according to the Böhler-Angle
With the help of CT-scan according to the evaluation of the subtalar joint
With the help of CT-scan according to number of fragments and displacement grade
With the help of CT-scan according to Sanders classification
With the help of CT-scan according to Zwipp classification
With the help of CT-scan according to another classification system
Other criteria
13.) Conservative treatment is done :
Extra-articular fractures
Intra-articular but nondisplaced fractures
Intra-articular and displaced fractures
Normal length of the calcaneus
Normal Böhler angle
Always
Never
Multiple comorbidities
Poor soft tissue conditions
Limited compliance of the patient
Smokers
Patients with mental illness
Every patient is being transferred to a medical center
14.) Criteria for closed reduction and percutaneous techniques:
Minor stages (Sanders/Zwipp etc.)
Sound posterior facet
Slightly changed Böhler angle
Minor displacement grade of the fracture
Older patients
Poorer overall condition (ASA 3 + 4)
More than 3 comorbidities
Poor soft tissue condition
Mental illness / poor compliance of the patient
By instinct of the surgeon
Smokers
Never
15.) Treatment preferences of a typical displaced intraarticular fracture of the
Joint – Depression - Type (Sanders II or III)
Conservative
Closed reduction, Kirschner wires
Open reduction through an extended lateral approach, Kirschner wires
Open reduction through an extended lateral approach, plate
Open reduction through an extended lateral approach, implant combination
Primary arthrodesis of the lower ankle joint
Additionally cancellous bone
Additionally bone substitutes
Other procedures, alternative approach
16.) Operation time for a displaced intraarticular fracture of the Joint-Depression-Type (Sanders II or III)
Till 60 minutes
Between 60 and 90 minutes
Between 91 and 120 minutes
Between 121 and 150 minutes
Between 151 and 180 minutes
Between 181 and 210 minutes
Between 211 and 240 minutes
More than 240 minutes
17.) The intraoperative examination of the reduction quality
Visually
Manually
X-ray (Broden View)
3 D image converter
Arthroscopic
No intraoperative examination
Other methods
18.) Postoperative CT scan
Yes
No
19.) Rate of infections and wound healing deficits after an extended lateral approach
0%
1 – 5 %
6 – 10 %
11 – 20 %
21 – 30 %
31 – 50 %
> 50 %
20.) Reoperation rate regarding infections and wound healing
0%
1 – 5 %
6 – 10 %
11 – 20 %
21 – 30 %
31 – 50 %
> 50 %
21.) Intravenous antibiosis are administered
Already preoperative
Intraoperative as single shot
Intraoperative and postoperative until three days
Intraoperative and postoperative until seven days
Longer
Not at all
22.) Main reasons for wound healing deficits
Long duration of operation (blood arrest)
Patient age over 50
Systemic diseases
Mental illness
Limited adherence
Limited microcirculation of the foot
Lower social status
Only few number of cases treated at hospital
Only few years of operative experience
Inadequate time to surgery
Smoking
Length of the lateral approach
Disregard of tissue – sparing operative techniques
Poor hygienic conditions at hospital
Inadequate postoperative treatment
Other criteria
23.) Who is the surgeon in calcaneus fractures
Chief
Consultant
Specialist registrar
Resident under supervision
24.) Usage of hyperbaric oxygenation in cases of wound healing deficits or critical soft tissue situation
Yes, even before operation in cases of critical soft tissue situations
Yes, always after operation
Yes, after operation in cases of wound healing deficits
No, never because hyperbaric oxygenation is ineffective
No, never because hyperbaric oxygenation is too expensive
Hyperbaric oxygenation is unknown
25.) Postoperative procedures within the first 8 weeks
Plaster cast
Vacoped brace
Hindfoot relief orthosis
No weight bearing
Partial weight bearing
Full weight bearing
Weight bearing according to the surgeon
There is a clear load scheme
26.) Average hospital stay
Under 5 days
5 till 8 days
8 till 11 days
11 till 14 days
More than 14 days
27.) Rate of secondary arthrodesis
1 till 5 %
6 till 10 %
11 till 20 %
21 till 30 %
31 till 50 %
51 till 75 %
More than 75 %
28.) Implant removal
Never
After 6 weeks
After 6 months
After 1 year
After 2 years
At a later time
In cases of complaints
29.) Minimally invasive procedures are
Urgently needed
Useful in the majority of cases
Advantageous only in occasional instances
Unreasonable and not conducive
30.) Cases of infections and required reoperation have influence on the functional outcome (measured with the help of scores)
No
Yes, due to scarring and initial required immobilization
Yes, due to synovialitis and early arthrosis
Yes, due to other mechanisms
Outcome – scores are not necessary
I do not know outcome – scores
31.) I am missing clear parameters and guidelines for decision making regarding percutaneous and open (extended lateral approach) techniques
No
Yes, better implants should be developed
Yes, better approaches should be developed
Yes, soft tissue – saving instruments should be developed
Yes, other research objectives