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: On intention to treat analysis (table 2), the Kerr-Atkins scores were similar between operative (69.8) and non-operative (65.7) groups after two years, with an unadjusted effect size of 4.1 points (95% confidence interval −3.4 to 11.5, P=0.28). No treatment effect was observed after adjustment for potential confounders (difference in Kerr-Atkins score −0.03, 95% confidence interval −7.08 to 7.02). Although the trial was not formally powered to assess the effects of fracture severity on outcome, table 2 shows estimated treatment effects for subgroups according to Sanders classification; a formal interaction test in the regression analysis showed no evidence (P=0.697) that the effect of surgery was affected by fracture severity. There was no evidence for treatment effects for general health (SF-36 physical or mental component scores), quality of life (EQ5-D), or hindfoot pain and function (American Orthopaedic Foot and Ankle Society score), table 2). Neither were there treatment effects of surgery for heel width, range of motion, walking speed, or any other metrics of gait symmetry. Range of motion and gait symmetry data are expressed as percentage changes compared with the non-injured foot in table 2, with raw data in figures 3 and 4.
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.