![]() This found no significant differences between surgical or conservative treatment in functional ability and health related quality of life at three years after displaced intra-articular calcaneal fracture. The bulk of the evidence in this review derives from one large multi-centre but inadequately reported trial conducted over 15 years ago. There were no significant differences between the two groups in range of movement outcomes or radiological measurements (e.g. Conversely, significantly fewer surgical participants had subtalar arthrodeses due to the development of subtalar arthritis (7/206 versus 37/218 RR 0.20, 95% CI 0.09 to 0.44 1 trial). ![]() ![]() There was a higher rate of major complications, such as surgical site infection, after surgery compared with conservative treatment (57/206 versus 42/218 RR 1.44, 95% CI 1.01 to 2.04 1 trial). One small trial found no difference between the two groups in the ability to wear normal shoes, whereas another small trial found that surgery resulted in more people who were able to wear all shoes comfortably. The multi-centre trial found no statistically or clinically significant difference between the two groups in health-related quality of life at three years follow-up (SF-36 (0 to 100: best outcome): MD 4.00, 95% CI -1.16 to 9.16 P = 0.13).Two small trials provided some limited evidence of a tendency for a higher return to previous employment after surgery (27/34 versus 15/27 RR 1.45, 95% CI 0.75 to 2.81 I² = 55% 2 trials). There was no significant difference between the two groups in the risk of chronic pain at follow-up (19/40 versus 24/42 risk ratio (RR) 0.79, 95% CI 0.53 to 1.18 2 trials). This showed no statistically or clinically significant differences between the surgical and conservatively treated groups at three years follow-up in the ''validated disease-specific" score (0 to 100: perfect result 424 participants mean difference (MD) 4.30, 95% confidence interval (CI) -1.11 to 9.71 P = 0.12). The strongest evidence was from the multi-centre trial. Follow-up ranged from 1 to 15 years after treatment.Data for functional outcomes, including walking ability, from three trials could not be pooled. All trials had methodological flaws, usually failure to conceal allocation and incomplete follow-up data, which put them at high risk of bias. Three trials were small single-centre trials, and the fourth a large multi-centre trial including 424 participants. Missing standard deviations were calculated from P values.įour trials were included (602 participants). Risk ratios were calculated for dichotomous outcomes and mean differences for continuous outcomes. Two review authors independently screened search results, selected studies, extracted data and assessed risk of bias. Randomised and quasi-randomised controlled clinical studies comparing surgical versus conservative management for displaced intra-articular calcaneal fractures. Reference lists of retrieved articles were checked. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to July 2011), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2011 Issue 3), MEDLINE (1948 to July 2011), EMBASE (1980 to 2011 Week 27), the WHO International Clinical Trials Registry Platform, Current Controlled Trials, and Orthopaedic Trauma Association annual meeting archives (1996 to 2011). To assess the effects of surgical compared with conservative treatment of displaced intra-articular calcaneal fractures in adults. ![]() Treatment can be surgical or non-surgical however, there is clinical uncertainty over optimal management. These fractures are mostly caused by a fall from a height, and are common in younger adults. Fractures of the calcaneus (heel bone) comprise up to 2% of all fractures.
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