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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:

I was involved in discussions about the format of this trial and we stated that the question which needed answering was whether the well reduced calcaneal fracture did better than the displaced, intra-articular fracture treated non operatively. Part of the protocol was to have a post operative CT scan to ascertain this. It is disappointing that the trial has not answered this important question. These fractures are difficult to fix well and there is a learning curve. Unless we know that the well reduced calcaneal fracture does no better than non operative treatment we cannot condemn operative treatment. Professor Griffin would argue that the study shows the results in the hands of the average Orthopaedic Surgeon interested in these fractures. That is not a scientific answer to whether the problem is the Surgeon or the surgery. Interest or experience is not a guarantee of a good reduction; we need a scientific answer. Regrettably the trial still does not answer the fundamental question.

Competing interests: No competing interests

12 August 2014
Patrick W Laing
Consultant Orthopaedic foot & ankle Surgeon
Wrexham Maelor hospital
Croesnewydd Road, Wrexham LL13 7TD