OTA 2005 Posters
Scientific Poster #85 Foot & Ankle
Performance of Three Disease-Specific and Two Generic Measures of Outcome in Patients with Talar Neck Fractures
Purpose: Few studies have compared various patient-oriented surveys in terms of their correlation and differences. This study aims to (1) determine functional outcomes of talus fractures using three disease-specific and two generic validated surveys, (2) analyze the degree of correlation among these surveys, and (3) compare the functional outcome for each survey to the population norms.
Methods: The SF-36 Health Survey, Short Musculoskeletal Functional Assessment (SMFA), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Maryland Foot Score (MFS), and the modified Boston Children's Hospital Ankle scoring system (MBCHAS) were used to determine functional measures. Comparison of multiple means using analysis of variance with post hoc t-tests was conducted. We used the least squares difference method to correct for multiple testing. The MBCHAS were transformed to scores out of 100 points to match all other scoring systems of 100 points maximum.
Results: 35 patients (mean age 49.3 ± 19 years) with 35 talar neck fractures were enrolled in the study. Mean follow-up was 15 months (range, 3 to 48 months). Mean AOFAS score was 49.7 (SD 27.1) with 2 excellent, 6 good, 8 fair, and 19 failed outcomes. Mean MFS was 62.6 (SD 22.9) with 7 excellent, 4 good, 12 fair, and 12 failed outcomes. Mean MBCHAS was 81.7 (SD 12.6) with 12 excellent, 16 good, 6 fair, and 1 failed outcomes. Mean scores were significantly different between the three scoring systems (P<0.001). The BCHAS was significantly higher than either AOFAS or MFS (P<0.001). MFS was greater than AOFAS (P=0.048). AOFAS was highly correlated with MFS (r=0.91, P<0.001) and MBCHAS (r=0.83, P<0.001). SMFA Bother Index and Function Index correlated well (P<0.01) with AOFAS (r=-0.79, r=-0.81) and MBCHAS (r=-0.81, r=-0.87). Outcome measures for physical function, role physical, bodily pain, and physical component summary were below the Canadian population norms (P<0.02).
Significance/Conclusion: The disease-specific measures of foot and ankle function are highly correlated; however, differences in mean scores suggest that these systems may be measuring different attributes of outcomes. MBCHAS may overestimate function, or AOFAS may underestimate function. Functional outcome following talar neck fractures is highly variable and overall is below Canadian population norms.