title: Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial.
abstract: OBJECTIVE
  To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures.
  
  
  METHODS
  Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial).
  
  
  METHODS
  22 tertiary referral hospitals, United Kingdom.
  
  
  METHODS
  151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment.
  
  
  METHODS
  The primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat.
  
  
  RESULTS
  95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group v 65.7 in non-operative group; adjusted 95% confidence interval of difference -7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8).
  
  
  CONCLUSIONS
  Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures.Trial registration Current Controlled Trials ISRCTN37188541.
authors: Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK damian.griffin@warwick.ac.uk.
authors: Damian
authors: D
authors: Griffin
authors: Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK.
authors: Nick
authors: N
authors: Parsons
authors: Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK.
authors: Ewart
authors: E
authors: Shaw
authors: Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK.
authors: Yuri
authors: Y
authors: Kulikov
authors: Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK.
authors: Charles
authors: C
authors: Hutchinson
authors: Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK.
authors: Margaret
authors: M
authors: Thorogood
authors: Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK.
authors: Sarah E
authors: SE
authors: Lamb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002111:Calcaneus / Q000293:injuries*; D005260:Female; D005592:Fracture Fixation / Q000379:methods* / Q000534:rehabilitation; D005593:Fracture Fixation, Internal / Q000379:methods / Q000534:rehabilitation; D050723:Fractures, Bone / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D005596:Fractures, Closed / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy; D006801:Humans; D057072:Intra-Articular Fractures / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D010349:Patient Compliance; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D016059:Range of Motion, Articular; D020127:Recovery of Function / Q000502:physiology; D012086:Reoperation / Q000523:psychology; D016896:Treatment Outcome; D055815:Young Adult