Dynamic and Functional Gait Analysis of Severely Displaced Intra-Articular Calcaneus Fractures Treated with a Hinged External Fixator or Internal Stabilization Lutz Besch, MD, 1 Birgit Radke, MD, 1 Michael Mueller, MD, 1 Mark Daniels-Wredenhagen, MD, MA, 2 Deike Varoga, MD, 2 Ralf-Erik Hilgert, MD, 1 Guenther Mathiak, MD, 3 Katharina Oehlert, PhD, 4 and Andreas Seekamp, MD, PhD 5 The purpose of this article was to assess functional gait outcome. Fifty-five patients with severely displaced intra-articular calcaneus fractures and soft tissue damage were evaluated prospectively with computerized dynamic pedography and a clinical scoring scale. The treatment protocol assigned 30 patients to open reduction and internal fixation (ORIF) and 25 to closed reduction and stabilization with a biomechanically tested hinged external fixator. Gait parameter was evaluated by measuring plantar pressure distribution, length of a double-step, double-step duration, standing duration, effective foot length, and width of gait. Pedographic measurements were performed with a custom-made gait analysis system (medilogic Gangas, Berlin, Germany). Results were graded by an extended protocol of ques- tionnaires and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scales. Radiographs were reviewed according to the Sanders classification at the time of follow-up (7.3 years). All measurements were statistically analyzed (t test; Mann-Whitney U test). Aberrations were associated with all calcaneal fractures in both groups. Dynamic gait analysis showed gait asymmetry in all patients. The type of treatment (ORIF or a hinged fixator) of severely displaced calcaneus fractures did not affect gait analysis nor result in significantly different (P  .05) patient outcome scores. The gait analysis system allows a valid dynamic pedographic measurement. The hinged external fixator can be recommended in displaced intra-articular calcaneal fractures with severe soft tissue damage to reduce complica- tions associated with ORIF. ACFAS Level of Clinical Evidence: 2c. (The Journal of Foot & Ankle Surgery 47(1):19 –25, 2008) Key Words: dynamic pedography, gait analysis, displaced intra-articular calcaneus fracture, hinged external Fixator, ORIF D islocated intra-articular calcaneus fractures frequently heal with deficits in the rolling-off motion of the foot (1). In complex fractures with extensive soft tissue damage and in combination injuries, ORIF may not be indicated because of its potential complications (2). A hinged external fixator can yield good results in this case (3). Standard methods of dynamic and static pedography can highlight gait differ- ences between the fractured calcaneus foot and the healthy foot. Little has been reported about this in the literature. Common scoring systems for evaluation after foot injury are not routinely used for gait analysis; an extension of the scoring system for dynamic pedography is suggested (4). Study designs, statistic evaluation, pedography platforms, stability devices, and treadmills vary greatly (5). The goal of this prospective study is to evaluate gait dysfunction after complex intra-articular calcaneus fractures using dynamic pedography and calcaneus scores after treatment using plate osteosynthesis and hinged external fixators and to compare these results to the uninjured side. Address correspondence to: Lutz Besch, MD, Department of Trauma- tology, University Medical Center Schleswig-Holstein, Kiel, Arnold- Heller-Straße 7, 24105 Kiel, Germany. E-mail: lutz.besch@uksh-kiel.de; lutz.besch@web.de. 1 Consultant Surgeon, Department of Traumatology, University Medical Center Schleswig-Holstein, Kiel, Germany. 2 Resident, Department of Traumatology, University Medical Center Schleswig-Holstein, Kiel, Germany. 3 External Consultant, Department of Traumatology, University Medical Center Schleswig-Holstein, Kiel, Germany. 4 Research Assistant, Department of Traumatology, University Medical Center Schleswig-Holstein, Kiel, Germany. 5 Director, Department of Traumatology, University Medical Center Schleswig-Holstein, Kiel, Germany. Copyright © 2008 by the American College of Foot and Ankle Surgeons 1067-2516/08/4701-0005$34.00/0 doi:10.1053/j.jfas.2007.10.013 VOLUME 47, NUMBER 1, JANUARY/FEBRUARY 2008 19