title: Open reduction and internal fixation compared with ORIF and primary subtalar arthrodesis for treatment of Sanders type IV calcaneal fractures: a randomized multicenter trial.
abstract: OBJECTIVE
  To compare long-term health outcome of Sanders type IV calcaneal fractures treated with open reduction and internal fixation (ORIF) versus ORIF plus primary subtalar arthrodesis (PSTA).
  
  
  METHODS
  Randomized prospective multicenter trial.
  
  
  METHODS
  Four Level 1 trauma hospitals in Canada.
  
  
  METHODS
  Thirty-one patients with 31 Sanders IV displaced intraarticular calcaneal fractures.
  
  
  METHODS
  Seventeen patients were treated with a standard protocol involving a lateral approach for ORIF. Fourteen patients were treated with a standard protocol involving a lateral approach with ORIF + PSTA.
  
  
  METHODS
  Health outcomes were assessed with 4 validated instruments: (1) the Short Form 36 version 2 (SF-36), (2) the Musculoskeletal Functional Assessment Survey, (3) the American Orthopaedic Foot and Ankle Society's Ankle-Hindfoot Scale, and (4) the Visual Analogue Scale.
  
  
  RESULTS
  From 2004 to 2011, 26 patients (26 displaced intraarticular calcaneal fractures) were followed for a minimum of 2 years (81% follow-up). No statistical difference was found between the results for ORIF compared with ORIF + PSTA: the mean SF-36 physical component scores were, respectively, 30.2 (SD = 11.4) and 37.8 (SD = 10.4) (P = 0.10); the mean Musculoskeletal Functional Assessment Survey scores were 44.2 (SD = 25.6) and 37.9 (SD = 21.5) (P = 0.50); the mean Ankle-Hindfoot Scale scores were 62.5 (SD = 19.6) and 65.8 (SD = 19.2), (P = 0.68); and the mean Visual Analogue Scale scores were 36.8 (SD = 34.7) and 36.0 (SD = 30.7) (P = 0.82).
  
  
  CONCLUSIONS
  We were unable to demonstrate a significant difference between treating Sanders type IV fractures with either ORIF or ORIF + PSTA. It remains the choice of the surgeon and patient to take into account patient specific factors to determine treatment. However, ORIF + PSTA may be advantageous for both patients with Sanders type IV fractures and the health care system as patients heal quickly. Furthermore, ORIF + PSTA may prevent the need for late secondary subtalar fusion adding to increased costs and lost time from work.
  
  
  METHODS
  Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Canadian Orthopaedic Trauma Society, Halifax, Nova Scotia Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Buckley
authors.forename: Ross
authors.initials: R
authors.lastname: Leighton
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Poon
authors.forename: Chad P
authors.initials: CP
authors.lastname: Coles
authors.forename: David
authors.initials: D
authors.lastname: Stephen
authors.forename: Elizabeth O
authors.initials: EO
authors.lastname: Paolucci
mesh_terms: D000328:Adult; D001174:Arthrodesis; D002111:Calcaneus / Q000293:injuries / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods* / Q000534:rehabilitation; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013628:Talus / Q000601:surgery; D055815:Young Adult