Session IV - Foot & Ankle

Fri., 10/19/01 Foot and Ankle, Paper #19, 8:00 AM

Complications after Displaced Intraarticular Calcaneal Fractures: Prospective Randomized Trial Comparing Open Reduction Internal Fixation with Nonoperative Treatment

J.L. Howard, MD; Richard E. Buckley, MD, FRCSC; Robert McCormack, MD, FRCSC; G. Pate, MD, FRCSC; Ross Leighton, MD, FRCSC; D. Petrie, MD, FRCSC; R. Galpin MD, FRCSC, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada

Objective: In a prospective, randomized, multicenter study, we analyzed all complications experienced by patients with a displaced intraarticular calcaneal fracture (DIACF) after nonoperative management or surgical treatment with open reduction internal fixation (ORIF).

Methods: The study population consisted of consecutive patients, 17 to 65 years of age at the time of injury, who presented to one of the four level-1 trauma centers with a DIACF between April 1991 and December 1998. Patients were randomly assigned to either the nonoperative treatment group or to operative reduction using a lateral approach to the calcaneus. Patients were examined at 2 weeks, 6 weeks, 3 months, 12 months, 24 months, and once more than 24 months after injury and were assessed for the development of major and minor complications. After a minimum of a 2-year follow-up, the patients were asked to fill out a validated visual analogue scale questionnaire (VAS) as well as a general health status review (SF-36).

Results: There were 233 DIACFs (218 patients) in the nonoperative group with 42 injuries (18%) resulting in major complications. There were 226 DIACFs (206 patients) in the ORIF group with 76 (34%) major complications.

Discussion: Complications, a cause of significant morbidity for patients, occur regardless of the treatment strategy chosen for DIACF and despite management by experienced surgeons. Outcome scores in this study tend to support the use of ORIF for calcaneal fractures. However, the high incidence of complications following ORIF in certain patient populations (WCB and Sanders class 4) supports the use of nonoperative treatment.

Conclusion: Careful selection of patients for ORIF or nonoperative treatment of DIACF will minimize complication rates.