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Rapid response to:


Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial

BMJ 2014; 349 doi: (Published 24 July 2014) Cite this as: BMJ 2014;349:g4483

Rapid Response:

This is one of the most important randomized trials studying the debatable issue of the best treatment for calcaneal fractures. However, the results should be taken cautiously as the study compared the results of operative versus non-operative treatment of “typical” closed intra-articular fracture of the calcaneus and excluded fractures with severe displacement. The word typical is not mentioned in the title and may give the impression that the results of the study can be applied for all displaced, intra-articular fractures.

In the conclusion it was mentioned that complications and reoperations were much more common in the operatively treated group. I can’t really see the point of comparing infection and reoperation rates in ORIF versus bed rest and foot elevation.

There were 57 patients with grossly displaced fractures showing “fibula impingement” excluded from the study, saying that they were absolutely indicated for operative treatment. The definition of fibula impingement was vague and did not have clear measurements, which would make it different from one surgeon to another according to personal judgment. Moreover, this group of patients is a subgroup of the patients mentioned in the title and if they were included in the study, results may have been different. This also means that study has excluded the subgroup of patients who would benefit most from operative treatment, which is not clear in the title or the abstract.

Competing interests: No competing interests

10 August 2014
Tamer A Sweed
Clinical fellow of Trauma & Orthopaedics
Sandwell & West Birmingham Hospital NHS Trust
Lyndon, West Bromwich, West Midlands B71 4HJ