Griffin, Damian R., Parsons, Nicholas R., Shaw, J. Ewart H., Kulikov, Yuri, Hutchinson, Charles E., Thorogood, Margaret and Lamb, S. E. (Sallie E.) (2014) Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus : randomised controlled trial. BMJ, Volume 349 . Article number g4483. doi:10.1136/bmj.g4483 ISSN 0959-535X.

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Abstract

Objective: To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures.

Design: Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial).

Setting: 22 tertiary referral hospitals, United Kingdom.

Participants: 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment.

Main outcome measures: The primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat.

Results: 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. 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).

Conclusions: 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. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Heel bone -- Fractures -- Treatment, Heel bone -- Fractures -- Surgery
Journal or Publication Title:	BMJ
Publisher:	BMJ Publishing Group Ltd.
ISSN:	0959-535X
Official Date:	July 2014
Dates:	Date Event July 2014 Published 25 June 2014 Accepted
Volume:	Volume 349
Article Number:	Article number g4483
DOI:	10.1136/bmj.g4483
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	28 December 2015
Date of first compliant Open Access:	28 December 2015
Funder:	Arthritis Research UK, University of Warwick, University Hospitals Coventry and Warwickshire NHS Trust
Grant number:	15964 (ARUK)

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