Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial.
Bottom Line: 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).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.
Affiliation: Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK email@example.com.Show MeSH
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Mentions: Overall, 2006 patients presented to the collaborating centres with calcaneal fractures. Of these, 502 had severe fractures that met the eligibility criteria (fig 1). An audit of all centres identified only three further patients with displaced, intra-articular fractures who might have been eligible for the trial. Of the 502 eligible patients, 151 consented to participate and were randomised to the operative (n=73) and non-operative (n=78) groups, with a median of 5 (interquartile range 4-8) participants per centre. The mean age of participants was 46.5 years (range 18-80), and 24 (16%) were women. No significant differences were found between treatment groups in sex, age, body mass index, smoking, prevalence of diabetes, or baseline scores (table 1). Follow-up for the primary outcome after two years was 95% in each group. All of the secondary outcome measures at all time points were available for 75% of the patients.
Affiliation: Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK firstname.lastname@example.org.