Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial

BMJ. 2014 Jul 24:349:g4483. doi: 10.1136/bmj.g4483.

Abstract

Objective: To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures.

Design: Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial).

Setting: 22 tertiary referral hospitals, United Kingdom.

Participants: 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment.

Main outcome measures: The primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat.

Results: 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group v 65.7 in non-operative group; adjusted 95% confidence interval of difference -7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8).

Conclusions: Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures.Trial registration Current Controlled Trials ISRCTN37188541.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Calcaneus / injuries*
  • Female
  • Fracture Fixation / methods*
  • Fracture Fixation / rehabilitation
  • Fracture Fixation, Internal / methods
  • Fracture Fixation, Internal / rehabilitation
  • Fractures, Bone / physiopathology
  • Fractures, Bone / rehabilitation
  • Fractures, Bone / therapy*
  • Fractures, Closed / physiopathology
  • Fractures, Closed / rehabilitation
  • Fractures, Closed / therapy
  • Humans
  • Intra-Articular Fractures / physiopathology
  • Intra-Articular Fractures / rehabilitation
  • Intra-Articular Fractures / therapy
  • Male
  • Middle Aged
  • Pain, Postoperative / etiology
  • Patient Compliance
  • Physical Therapy Modalities
  • Pilot Projects
  • Range of Motion, Articular
  • Recovery of Function / physiology
  • Reoperation / psychology
  • Treatment Outcome
  • Young Adult

Associated data

  • ISRCTN/ISRCTN37188541