title: Displaced intraarticular calcaneal fractures: long-term outcome in women.
abstract: BACKGROUND
  This study compared the outcomes of displaced intraarticular calcaneal fractures in women treated operatively or nonoperatively. This was part of a prospective, randomized, controlled, multi-center, clinical trial performed at four level I trauma hospitals. In addition, we compared the long-term outcomes in women with those reported in men in an earlier study.
  
  
  METHODS
  Forty-one women (43 fractures) required treatment for displaced intraarticular calcaneal fractures. Patients' ages ranged from 17 to 65 years at the time of injury. All fractures were closed injuries and had posterior facet displacement of more than 2 mm. Patients were randomly assigned to either the nonoperatively or operatively treated groups. Nonoperative treatment included ice and elevation, while operative treatment consisted of open reduction and internal fixation using a standard lateral approach. Outcomes were measured using the validated Short Form-36 Health Survey (SF-36) and the Visual Analogue Scale (VAS).
  
  
  RESULTS
  Women were 3.18 times (RR 3.18, 95% CI 1.03- 9.79) more likely to report high SF-36 scores after operative treatment than those who received nonoperative treatment. Operative outcomes in women were better than those reported in an earlier study in men (SF-36: 77.47 in women compared to 67.56 in men, p = .07; VAS: 81.47 in women compared to 67.04 in men, p = .01). In women the fractures generally were caused by low-energy trauma that produced less severe injuries (higher Bohler angles). Most patients were not receiving Workman's Compensation benefits and did light to moderate work.
  
  
  CONCLUSIONS
  Operative treatment of the fractures showed statistically significant better results when compared to nonoperative treatment (SF-36: p = .04; VAS: p = .10) in women. Displaced intraarticular calcaneal fractures in women should be treated by open reduction and internal fixation through a lateral approach.
authors.affiliation: Foothills Hospital, Calgary, AB T2N 2T9, Canada.
authors.forename: Jorge
authors.initials: J
authors.lastname: Barla
authors.forename: Richard
authors.initials: R
authors.lastname: Buckley
authors.forename: Robert
authors.initials: R
authors.lastname: McCormack
authors.forename: Graham
authors.initials: G
authors.lastname: Pate
authors.forename: Ross
authors.initials: R
authors.lastname: Leighton
authors.forename: Dave
authors.initials: D
authors.lastname: Petrie
authors.forename: Robert
authors.initials: R
authors.lastname: Galpin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000293:injuries / Q000601:surgery*; D005260:Female; D033023:Foot Joints / Q000293:injuries / Q000601:surgery*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery / Q000628:therapy*; D006306:Health Surveys; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome