Editorials

Calcaneal fractures

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4779 (Published 24 July 2014) Cite this as: BMJ 2014;349:g4779
  1. Brigitte E Scammell, professor of orthopaedic sciences
  1. 1Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
  1. B.Scammell{at}nottingham.ac.uk

Surgery is no longer justified for most intra-articular displaced fractures

Displaced fractures of the calcaneus, or heel bone, are a serious injury and the outlook for patients, who are typically young, remains poor. Usually due to a fall from a height at work or a road traffic incident, calcaneal fractures are often intra-articular and displaced, affecting primarily the subtalar joint. These fractures will heal if treated non-operatively, but patients can be left with persistent deformity, incongruent joint surfaces, and loss of alignment of the leg to the heel. A two year recovery, with a stiff, painful, deformed foot that will not fit into a normal shoe and osteoarthritis of the subtalar joint are common outcomes.1

Orthopaedic surgeons often fix these fractures internally to try to improve the final result. Does internal fixation work? In a linked paper (doi:10.1136/bmj.g4483), Griffin and colleagues report the results of a pragmatic, multicentre, randomised controlled trial comparing operative with non-operative care of closed, displaced intra-articular calcaneal fractures two years after injury.2 They excluded open injuries and grossly displaced fractures, where surgery is absolutely indicated. Overall, they screened 2006 patients with calcaneal fractures, of whom a quarter (n=502) were eligible …

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