Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: A prospective, randomized, controlled multicenter trial

Abstract

To date, open reduction and internal fi xation is the treatment of choice for displaced intra-articular calcaneal fractures at many orthopedic trauma centers. The purpose of this study was to determine whether open reduction and internal fi xation of displaced intra-particular calcaneal fractures result in better generic and disease-specifi c health outcomes at 2 years after the injury compared with those after non-operative management. Patients at four trauma centres were randomized to operative or non-operative care. A standard protocol, involving a lateral approach and rigid internal fi xation, was used for operative care. Non-operative treatment involved no attempt at closed reduction, and the patients were treated only with ice, elevation, and rest. All fractures were classifi ed, and the quality of the reduction was measured. There were 206 patients with 249 fractures in the operative group and 218 with 262 fractures in the non-operative group The article is a prospective, randomized multicenter study which concludes that operative treatment provides no improvement over non-operative care on the basis of subjective and objective outcome measurements (clinical parameters with regard to gait, radiographic and computed tomographic fi ndings, and health-related quality-of-life measures, including the visual analog pain scale and the SF-36). However, stratifi cation of the patient population and clinical outcome information distinguished certain features that favour surgical care. Patients who were younger, female, had a light or moderate workload involving the foot, and those who were not receiving workers' compensation did better with operative care and had a better quality of life, as measured by visual analog pain scores and SF-36 values.