Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial
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 Fra...
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| Veröffentlicht in: | BMJ (Online) 2014-07, Vol.349 (jul24 5), p.g4483-g4483 |
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| creator | Griffin, Damian Parsons, Nick Shaw, Ewart Kulikov, Yuri Hutchinson, Charles Thorogood, Margaret Lamb, Sarah E |
| description | 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.Trial registration Current Controlled Trials ISRCTN37188541. |
| doi_str_mv | 10.1136/bmj.g4483 |
| format | Article |
| fullrecord | <record><control><sourceid>jstor_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4109620</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>26516639</jstor_id><sourcerecordid>26516639</sourcerecordid><originalsourceid>FETCH-LOGICAL-b454t-c9b8fcfaaa56d786744b61758b6da8607ce805e09393d3b7adda3791283f44903</originalsourceid><addsrcrecordid>eNp1kcuKFDEUhoMoTtPOwgdQArpQsMakcp-FMAzeYGA2ug6nUqmZatKVNkk1-AS-9qTssb2A2eSQ8-XP-fMj9JSSM0qZfNttN2c3nGv2AK2oErKhmrGHaEWMMI2mTJ-g05w3hJCWKW2keIxOWkGEUVyt0I_rnU9Qxr3He5_ynPEUpyYeD0vyULZ-KniICbsQs-_f4H7MuwBuKcepJGggldHNARIeErgyJ59xHHC59dhBcDD5OZ_jBFMft2OVwC7WezGEWpY0QniCHg0Qsj-939fo64f3Xy4_NVfXHz9fXlw1HRe8NM50enADAAjZKy0V552srnUne9CSKOc1EZ4YZljPOgV9D0wZ2mo2cG4IW6N3B93d3G197_wyfrC7NG4hfbcRRvt3Zxpv7U3cW06Jke0i8OpeIMVvs8_FVkPOh1A9xjlbKriWnAq5oC_-QTdxTlO1Z6mqS-uW8kq9PlAuxZyTH47DUGKXhG1N2P5MuLLP_5z-SP7KswLPDsAml5h-96WgUtY_WaOXh_6i-f937gAdF7pH</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1777788214</pqid></control><display><type>article</type><title>Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><source>Jstor Complete Legacy</source><creator>Griffin, Damian ; Parsons, Nick ; Shaw, Ewart ; Kulikov, Yuri ; Hutchinson, Charles ; Thorogood, Margaret ; Lamb, Sarah E</creator><creatorcontrib>Griffin, Damian ; Parsons, Nick ; Shaw, Ewart ; Kulikov, Yuri ; Hutchinson, Charles ; Thorogood, Margaret ; Lamb, Sarah E ; UK Heel Fracture Trial Investigators ; for the UK Heel Fracture Trial (UK HeFT) investigators</creatorcontrib><description>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.Trial registration Current Controlled Trials ISRCTN37188541.</description><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 1756-1833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.g4483</identifier><identifier>PMID: 25059747</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ankle ; Calcaneus - injuries ; Developing countries ; Emergency medical care ; Female ; Fracture Fixation - methods ; Fracture Fixation - rehabilitation ; Fracture Fixation, Internal - methods ; Fracture Fixation, Internal - rehabilitation ; Fractures ; Fractures, Bone - physiopathology ; Fractures, Bone - rehabilitation ; Fractures, Bone - therapy ; Fractures, Closed - physiopathology ; Fractures, Closed - rehabilitation ; Fractures, Closed - therapy ; Hospitals ; Humans ; Injuries ; Intra-Articular Fractures - physiopathology ; Intra-Articular Fractures - rehabilitation ; Intra-Articular Fractures - therapy ; LDCs ; Male ; Middle Aged ; Orthopedics ; Pain, Postoperative - etiology ; Patient Compliance ; Patients ; Physical therapy ; Physical Therapy Modalities ; Pilot Projects ; Range of Motion, Articular ; Recovery of Function - physiology ; Reoperation - psychology ; Surgeons ; Surgery ; Tomography ; Treatment Outcome ; Young Adult</subject><ispartof>BMJ (Online), 2014-07, Vol.349 (jul24 5), p.g4483-g4483</ispartof><rights>Griffin et al 2014</rights><rights>Griffin et al 2014.</rights><rights>Copyright BMJ Publishing Group LTD Jul 24, 2014</rights><rights>Griffin et al 2014 2014 Griffin et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b454t-c9b8fcfaaa56d786744b61758b6da8607ce805e09393d3b7adda3791283f44903</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/349/bmj.g4483.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmj.com/content/349/bmj.g4483.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>114,115,230,314,777,781,800,882,3183,23552,27905,27906,57998,58231,77349,77380</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25059747$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Griffin, Damian</creatorcontrib><creatorcontrib>Parsons, Nick</creatorcontrib><creatorcontrib>Shaw, Ewart</creatorcontrib><creatorcontrib>Kulikov, Yuri</creatorcontrib><creatorcontrib>Hutchinson, Charles</creatorcontrib><creatorcontrib>Thorogood, Margaret</creatorcontrib><creatorcontrib>Lamb, Sarah E</creatorcontrib><creatorcontrib>UK Heel Fracture Trial Investigators</creatorcontrib><creatorcontrib>for the UK Heel Fracture Trial (UK HeFT) investigators</creatorcontrib><title>Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>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.Trial registration Current Controlled Trials ISRCTN37188541.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ankle</subject><subject>Calcaneus - injuries</subject><subject>Developing countries</subject><subject>Emergency medical care</subject><subject>Female</subject><subject>Fracture Fixation - methods</subject><subject>Fracture Fixation - rehabilitation</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Fracture Fixation, Internal - rehabilitation</subject><subject>Fractures</subject><subject>Fractures, Bone - physiopathology</subject><subject>Fractures, Bone - rehabilitation</subject><subject>Fractures, Bone - therapy</subject><subject>Fractures, Closed - physiopathology</subject><subject>Fractures, Closed - rehabilitation</subject><subject>Fractures, Closed - therapy</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Injuries</subject><subject>Intra-Articular Fractures - physiopathology</subject><subject>Intra-Articular Fractures - rehabilitation</subject><subject>Intra-Articular Fractures - therapy</subject><subject>LDCs</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Pain, Postoperative - etiology</subject><subject>Patient Compliance</subject><subject>Patients</subject><subject>Physical therapy</subject><subject>Physical Therapy Modalities</subject><subject>Pilot Projects</subject><subject>Range of Motion, Articular</subject><subject>Recovery of Function - physiology</subject><subject>Reoperation - psychology</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Tomography</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0959-8138</issn><issn>1756-1833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kcuKFDEUhoMoTtPOwgdQArpQsMakcp-FMAzeYGA2ug6nUqmZatKVNkk1-AS-9qTssb2A2eSQ8-XP-fMj9JSSM0qZfNttN2c3nGv2AK2oErKhmrGHaEWMMI2mTJ-g05w3hJCWKW2keIxOWkGEUVyt0I_rnU9Qxr3He5_ynPEUpyYeD0vyULZ-KniICbsQs-_f4H7MuwBuKcepJGggldHNARIeErgyJ59xHHC59dhBcDD5OZ_jBFMft2OVwC7WezGEWpY0QniCHg0Qsj-939fo64f3Xy4_NVfXHz9fXlw1HRe8NM50enADAAjZKy0V552srnUne9CSKOc1EZ4YZljPOgV9D0wZ2mo2cG4IW6N3B93d3G197_wyfrC7NG4hfbcRRvt3Zxpv7U3cW06Jke0i8OpeIMVvs8_FVkPOh1A9xjlbKriWnAq5oC_-QTdxTlO1Z6mqS-uW8kq9PlAuxZyTH47DUGKXhG1N2P5MuLLP_5z-SP7KswLPDsAml5h-96WgUtY_WaOXh_6i-f937gAdF7pH</recordid><startdate>20140724</startdate><enddate>20140724</enddate><creator>Griffin, Damian</creator><creator>Parsons, Nick</creator><creator>Shaw, Ewart</creator><creator>Kulikov, Yuri</creator><creator>Hutchinson, Charles</creator><creator>Thorogood, Margaret</creator><creator>Lamb, Sarah E</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140724</creationdate><title>Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial</title><author>Griffin, Damian ; Parsons, Nick ; Shaw, Ewart ; Kulikov, Yuri ; Hutchinson, Charles ; Thorogood, Margaret ; Lamb, Sarah E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b454t-c9b8fcfaaa56d786744b61758b6da8607ce805e09393d3b7adda3791283f44903</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ankle</topic><topic>Calcaneus - injuries</topic><topic>Developing countries</topic><topic>Emergency medical care</topic><topic>Female</topic><topic>Fracture Fixation - methods</topic><topic>Fracture Fixation - rehabilitation</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Fracture Fixation, Internal - rehabilitation</topic><topic>Fractures</topic><topic>Fractures, Bone - physiopathology</topic><topic>Fractures, Bone - rehabilitation</topic><topic>Fractures, Bone - therapy</topic><topic>Fractures, Closed - physiopathology</topic><topic>Fractures, Closed - rehabilitation</topic><topic>Fractures, Closed - therapy</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Injuries</topic><topic>Intra-Articular Fractures - physiopathology</topic><topic>Intra-Articular Fractures - rehabilitation</topic><topic>Intra-Articular Fractures - therapy</topic><topic>LDCs</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Pain, Postoperative - etiology</topic><topic>Patient Compliance</topic><topic>Patients</topic><topic>Physical therapy</topic><topic>Physical Therapy Modalities</topic><topic>Pilot Projects</topic><topic>Range of Motion, Articular</topic><topic>Recovery of Function - physiology</topic><topic>Reoperation - psychology</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Tomography</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Griffin, Damian</creatorcontrib><creatorcontrib>Parsons, Nick</creatorcontrib><creatorcontrib>Shaw, Ewart</creatorcontrib><creatorcontrib>Kulikov, Yuri</creatorcontrib><creatorcontrib>Hutchinson, Charles</creatorcontrib><creatorcontrib>Thorogood, Margaret</creatorcontrib><creatorcontrib>Lamb, Sarah E</creatorcontrib><creatorcontrib>UK Heel Fracture Trial Investigators</creatorcontrib><creatorcontrib>for the UK Heel Fracture Trial (UK HeFT) investigators</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ (Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Griffin, Damian</au><au>Parsons, Nick</au><au>Shaw, Ewart</au><au>Kulikov, Yuri</au><au>Hutchinson, Charles</au><au>Thorogood, Margaret</au><au>Lamb, Sarah E</au><aucorp>UK Heel Fracture Trial Investigators</aucorp><aucorp>for the UK Heel Fracture Trial (UK HeFT) investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial</atitle><jtitle>BMJ (Online)</jtitle><addtitle>BMJ</addtitle><date>2014-07-24</date><risdate>2014</risdate><volume>349</volume><issue>jul24 5</issue><spage>g4483</spage><epage>g4483</epage><pages>g4483-g4483</pages><issn>0959-8138</issn><issn>1756-1833</issn><eissn>1756-1833</eissn><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.Trial registration Current Controlled Trials ISRCTN37188541.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>25059747</pmid><doi>10.1136/bmj.g4483</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0959-8138 |
| ispartof | BMJ (Online), 2014-07, Vol.349 (jul24 5), p.g4483-g4483 |
| issn | 0959-8138 1756-1833 1756-1833 |
| language | eng |
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| source | MEDLINE; BMJ Journals - NESLi2; Jstor Complete Legacy |
| subjects | Adolescent Adult Aged Aged, 80 and over Ankle Calcaneus - injuries Developing countries Emergency medical care Female Fracture Fixation - methods Fracture Fixation - rehabilitation Fracture Fixation, Internal - methods Fracture Fixation, Internal - rehabilitation Fractures Fractures, Bone - physiopathology Fractures, Bone - rehabilitation Fractures, Bone - therapy Fractures, Closed - physiopathology Fractures, Closed - rehabilitation Fractures, Closed - therapy Hospitals Humans Injuries Intra-Articular Fractures - physiopathology Intra-Articular Fractures - rehabilitation Intra-Articular Fractures - therapy LDCs Male Middle Aged Orthopedics Pain, Postoperative - etiology Patient Compliance Patients Physical therapy Physical Therapy Modalities Pilot Projects Range of Motion, Articular Recovery of Function - physiology Reoperation - psychology Surgeons Surgery Tomography Treatment Outcome Young Adult |
| title | Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial |
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