Operative treatment of displaced intra-articular fractures of Calcaneum: Is it worthwhile?

Objective: To compare the results of operative treatment for displaced intra-articular fractures of calcaneum with conservative treatment. Methods: The retrospective non-randomised comparative study using. purposive non-probability convenient sampling was conducted at the Combined Military Hospital, Rawalpindi, and comprised treatment records from March 2010 to October 2013 of patients who had been treated either by Plaster of Paris casting (Group A) or managed by open reduction internal fixation (Group B). Functional outcome was assessed using Foot and Ankle Disability Index. Results: Of the 42 records in the study, 20(47.6%) related to Group A and 22(52.4%) to Group B. The mean age was 41 +/- 7.82 years (range: 28-55 years) in Group A, and 31 +/- 6.35 years (range: 21-43) in Group B. Male-to-female ratio was 10:1 in Group A; 9:1 in Group B. Union was achieved in all (100%) cases. Bone substitute was used in 16(72.7%) in Group B to fill void during reconstruction of collapsed calcaneum. Wound complications were noted in 2(9.1%) Group B patients. There was loss of reduction in 1(4.5%). Mean Foot and Ankle Disability Index score in Group A was 45 +/- 10.68.4 compared to 67.9 +/- 10.04 in Group B (p=1.99). Conclusion: For displaced intra-articular fractures, operative treatment is associated with better functional outcome in terms of absolute functional scores and should be the treatment of choice although factors such as age, soft tissue injury and surgical expertise may influence the decision.