Displaced intra-articular calcaneal fractures: 15-Year follow-up of a randomised controlled trial of conservative versus operative treatment

Summary Aim To report the 15-year follow-up of displaced intra-articular calcaneal fractures from a randomised controlled trial of conservative versus operative treatment published in 1993. Patients and methods Of the initial study, 46 patients (82%) were still alive at a mean of 15 years post injury and 26 patients (57%) agreed to review. The patients had been randomly allocated to either conservative or operative treatment in the original study. Clinical [American orthopaedic foot and ankle society hindfoot scale (AOFAS), foot function index (FFI) and calcaneal fracture score] and radiological (Böhler's angle and calcaneum height) outcome measures were used. The grade of osteoarthritis was also assessed at long-term follow-up. Results At long-term follow-up, the clinical outcomes were not different between conservative versus operative treatment. AOFAS hindfoot scale: conservative = 78.5 and operative = 70, p = 0.11; FFI: conservative = 24.4 and operative = 26.9, p = 0.66; calcaneal fracture score: conservative = 70.1 and operative = 63.5, p = 0.41. The radiological outcomes were also not different between both groups. Böhler's angle: conservative = 10.4° and operative 16.9°, p = 0.07; height of calcaneum: conservative = 37.2 mm and operative = 38.2 mm, p = 0.57; grade of osteoarthritis of the sub-talar joint: p = 0.54. There was no correlation between Böhler's angle and the outcome measures in either group. Conclusion The results of this 15-year follow-up of displaced intra-articular calcaneal fracture randomised controlled trial were equivalent between conservative and operative treatment and demonstrate similar findings to those at one year follow-up.