title: Outcome of calcaneal fractures treated operatively and non-operatively. the effect of litigation on outcomes.
abstract: BACKGROUND
  The optimum management of calcaneal fractures is controversial. These injuries are frequently associated with compensation litigation, which effects the outcome.
  
  
  OBJECTIVE
  To assess the outcome of operatively and conservatively managed intra-articular calcaneal fractures and to examine the effect of compensation litigation on outcome.
  
  
  METHODS
  This was a retrospective study of calcaneal fractures from a single regional trauma unit, with management decided by the admitting consultant surgeon's preference. Fifty-four patients (33 operative, 21 conservative) with an average follow-up of 40 months (range 14-78 months) were reviewed. Sixteen patients (30%) were pursuing a compensation case resulting from the injury.
  
  
  RESULTS
  Despite similar fractures, medical co-morbidity and trauma energy, significantly worse outcome scores were seen in litigants (p < 0.0001). Footwear fitting problems were greater in litigants. Time off work was more than twice that of non-litigants (14.5 vs 6 months, p < 0.01). Results were similar between the operative and non-operative groups in terms of functional score, footwear problems and time off work.
  
  
  CONCLUSIONS
  Litigation was the major determinant of outcome following calcaneal fracture repair; highlighting the unreliability of subjective evaluation in determining outcome in the face of litigation. No subset of patients appeared to significantly benefit from internal fixation of their fracture.
authors.affiliation: Department of Orthopaedic Surgery, Waterford Regional Hospital, Ireland. brianthornes@esatclear.ie
authors.forename: B S
authors.initials: BS
authors.lastname: Thornes
authors.forename: A L
authors.initials: AL
authors.lastname: Collins
authors.forename: M
authors.initials: M
authors.lastname: Timlin
authors.forename: J
authors.initials: J
authors.lastname: Corrigan
mesh_terms: D000041:Absenteeism; D002111:Calcaneus / Q000293:injuries*; D016022:Case-Control Studies; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012775:Shoes; D016896:Treatment Outcome; D014942:Workers' Compensation / Q000331:legislation & jurisprudence*
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