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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:

Congratulations to the authors on this lanmark achievement. However, I join my voice to obections over the rather sensationalized headline in the BMJ “Calcaneal fractures: surgery provides no benefits”. Clearly this headline does not read into the exclusion criteria where surgery was indicated for gross displacement and Fibular impingement. This headline also does not read into the actual results of the study. The average reported outcom at 24 Months was 65-70 which reads as a Bad Outcome! I believe the correct reporting of these results should be: “the results of treatment of calcaneal fractures are still disappointing!! And traditional extensile surgical have no benefit!”
The Canadian trial by Buckley et al 1 which was mentioned is the discussion made an important stratification of patients and after removal of the patients who were receiving Workers' Compensation, the outcomes were significantly better in some groups of surgically treated patients. This is particularly important when the main outcome score is patient reported
I hope that the orthopaedic community will pick up on this study as a challenge to current practices. The typical employment age patient with a heel bone fracture is still looking at a poor outcome and the field is open for novel aproaches to solve this clinical dillemma.
1. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective randomized controlled multicenter trial. J Bone Joint Surg Am2002;84-A:1733-44.

Competing interests: No competing interests

23 August 2014
Kenan Dehne
Orthopaedic Surgeon
Walsall Healthcare NHS trust
Moat Road, Walsall, WS2