Cast-treated XXXX : a prospective cohort study of radiological outcomes and their association with impaired calcaneal @entity79 .

@entity1 @entity174 @entity170 @entity79 @entity2331
INTRODUCTION: We hypothesized that treating @entity174 with cast only or closed reduction and cast is associated with high malunion risk and that the risk is higher in @entity1 with low @entity79 ( @entity79 ). MATERIALS AND METHODS: We prospectively studied 130 @entity1 aged 40  years or older with @entity174 treated with cast only (87 @entity1 ) or closed reduction and cast (43 @entity1 ). Radiographs were obtained before treatment, after reduction (in the closed reduction group), and at 1  year. We measured calcaneal @entity79 with DXA scanner and calculated T scores. We calculated radiological changes from baseline (initial radiographs in cast only and post-reduction radiographs in closed reduction @entity1 ) to 1  year. We assessed the relationship between @entity79 status (normal, @entity2331 or @entity170 ) and baseline-to-1-year worsening in volar tilt, ulnar variance, and radial inclination with analysis of covariance adjusting for baseline radiological values. We used receiver operating characteristic (ROC) analysis to determine the ability of T scores to distinguish @entity1 with severe malunion (dorsal tilt >25   and/or ulnar variance >= 5  mm) from those with less severe or no malunion. RESULTS: In both treatment groups, baseline radiological variables had deteriorated at 1  year, more in the closed reduction group. Compared to @entity1 with normal @entity79 , those with @entity170 had significantly greater worsening in volar tilt and radial inclination but did not differ in ulnar variance worsening. Severe malunion was found in 34 @entity174 (26  %, 15 in cast only group); T scores had a modest ability in distinguishing severe malunion (area under ROC curve 0.67, 95  % CI 0.56-0.78, p  =  0.003). CONCLUSIONS: Closed reduction and cast is not an effective treatment for @entity174 if radiological graphic outcomes are considered. There is a higher risk of malunion involving dorsal and radial tilt in @entity1 with @entity170 . Calcaneal @entity79 measurement may have some benefit in predicting the risk of severe malunion.
