f AAOS On-Line Service Academy News - Finds operative treatment for calcaneus fracture better than nonoperative

Friday February 23, 1996

Finds operative treatment for calcaneus fracture better than nonoperative

A study demonstrating the superior results of operative treatment for intra-articular calcaneus (heel joint surface) fractures versus nonoperative treatment was presented Thursday in scientific paper 81.

In a prospective randomized trial, 30 patients with these complex fractures were studied. Of the 26 patients who participated in a 14- to 16-month follow-up, seven patients had excellent outcomes; five, good; two, fair; and one, poor. The nonoperative group displayed less favorable results-one excellent, three, good; one, fair; and six, poor.

All patients in the study had early mobilization and delayed weight bearing. The average functional score for the operative group was far superior at 86.7, versus 55.0 for the nonoperative group, with the operative group experiencing less pain and fewer restrictions in their daily activity level, walking, exercise, and ability to work.

Range of motion averaged 20 degrees for the operative group, compared to 17 degrees for the nonoperative group. Pain levels for extremes of motion were only 25 percent for the operative patients compared to 100 percent for the nonoperative patients.

David B. Thordarson, MD, assistant professor in the department of orthopaedics at the University of Southern California, Los Angeles, explained that the operative fractures were treated by open reduction and rigid internal fixation with a plate and screws using an L-shaped lateral approach.

The 11 nonoperative patients had treatment that included ice, elevation, and a bulky dressing until initial edema subsided, followed by a removable posterior splint.

Participants in the study were between 18 and 60 years of age, with the average person in both groups being in their mid-thirties. All underwent a CT scan to define the anatomy of the fracture. Only fractures that had two or three major articular fragments were randomized into the study.

To assure that procedures were comparable, Dr. Thordarson performed all surgeries, and Lauren Eric Krieger, MD, a fourth year resident also from the department of orthopaedics, University of Southern California, administered all initial questionnaires and performed physical examinations of the patients, but was not involved in surgical or follow-up treatment.

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