Management of calcaneal fractures: systematic review of randomized trials.
BACKGROUND
The optimal management of calcaneal fractures is controversial, as correlation between anatomical restoration and outcome has not been proven, and complications after surgery are frequent.


METHODS
MEDLINE, EMBASE, CINAHL, Google scholar, the Cochrane Controlled Trials Register, and the Cochrane Musculoskeletal Injuries Group Trials Register were searched using the keywords 'calcaneal' and 'fractures', without time limits or restriction to language. Randomized and quasi-randomized trials were included. Two separate comparisons were identified in the trials: operative versus non-operative management (five studies), and impulse compression versus no impulse compression (one study). Two reviewers independently assessed trial quality, with a 12-item scale used by the Cochrane Collaboration.


RESULTS
Results showed no difference in residual pain, but favoured surgical management on ability to return to the same work and to wear the same shoes as before the fracture. Surgery reduced the need for subsequent subtalar fusion. workers' compensation affected outcome.


RESULTS
It is unclear whether general health outcome measures, injury specific scores and radiographic parameters improve after operative management, and whether the benefits of surgery outweigh the risks.


CONCLUSIONS
The existing trials are of relatively poor quality.


CONCLUSIONS
There is still a need for a carefully designed large-scale trial comparing surgery and non-operative management. Other forms of fixation (external fixation or minimally invasive internal fixation) should be compared with 'conventional' surgery. Trials investigating joint reconstruction versus primary subtalar fusion for highly comminuted fractures, and impulse compression versus placebo could be of value.
Gougoulias
Nikolaos
N
Department of Trauma and Orthopaedic Surgery, University Hospital of North Staffordshire, Stoke on Trent, Staffordshire, UK.
Khanna
Anil
A
McBride
Donald J
DJ
Maffulli
Nicola
N
D002111:Calcaneus / Q000293:injuries*; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic