Are Results of Surgical Treatment for Calcaneal Fractures better than Nonoperative Treatment?

Abstract

ABSTRACT The methods of treatment of displaced intra-articular calcaneal fractures (DIACFs) have always been surrounded by controversies, whether operative treatment is better or conservative. Some randomized controlled trials (RCTs) have been published comparing the operative vs conservative management options for DIACFs, but the conclusions are varied, with some of them supporting operative treatment while others showing equivocal results. To get some clarity on this subject, we reviewed 9 RCTs and 4 meta-analyses to evaluate the evidence that was present for both operative and nonoperative methods of management. Most studies report equivocal outcomes of operatively and nonoperatively managed DIACFs when looked at; however on stratification of groups, the evidence seemingly points towards better functional results in the operated patients who do not develop a complication, but poorer outcomes in patients with more severe injury patterns (higher Sanders’ Type). Complications were associated with both groups; no differentiation between closed and open fractures is made in most studies, leading to slightly higher rate of complications in the operated group (probably due to open cases inclusion); nevertheless the difference was not found significant. Despite a high level of interest in calcaneal fractures, the current evidence in published literature does not support a specific management protocol for DIACFs, although detailed analysis points to importance of patient selection, surgeon experience and soft tissue status. As of today, there is a need for larger randomized trials, which should also clarify the role of extensile approach vis a vis Minimally Invasive Surgery, to address this question and bring out a conclusive answer. How to cite this article Dhillon MS, Gahlot N. Are Results of Surgical Treatment for Calcaneal Fractures better than Nonoperative Treatment? J Foot Ankle Surg (Asia-Pacific) 2014; 1(1):17-23.