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Fractures: Bone Repair

Fractures: Bone Repair

Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...

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Calcaneal fractures: selection bias is key.

C J Pearce¹, K L Wong², J D F Calder³

¹Alexandra Hospital, 378 Alexandra Road, 159964, Singapore.

The Bone & Joint Journal

|July 2, 2015

Summary

The United Kingdom Heel Fracture Trial found no surgical advantage for calcaneal fractures when excluding patients needing surgery. However, selection bias may limit conclusions about surgical treatment for most intra-articular calcaneal fractures.

Keywords:

Calcaneal fracture

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Area of Science:

Orthopedic surgery
Traumatology
Clinical trial appraisal

Background:

The United Kingdom Heel Fracture Trial recently published findings on calcaneal fracture management.
The trial excluded patients with absolute indications for surgery.
This exclusion criteria may impact the generalizability of the results.

Purpose of the Study:

To critically appraise the methodology and conclusions of the United Kingdom Heel Fracture Trial.
To evaluate the potential impact of selection bias on the trial's findings regarding surgical versus non-surgical treatment of calcaneal fractures.

Main Methods:

Critical appraisal of a published randomized controlled trial.
Analysis of patient selection criteria and its potential influence on outcomes.
Review of evidence comparing surgical and non-surgical management of calcaneal fractures.

Main Results:

The trial concluded no advantage of surgical over non-surgical treatment when excluding patients with absolute surgical indications.
The authors of this appraisal suggest that selection bias was present in the trial.
This bias may prevent definitive conclusions regarding the efficacy of surgery for most intra-articular calcaneal fractures.

Conclusions:

The exclusion of surgically indicated patients limits the trial's conclusions.
Selection bias may have skewed the results, questioning the universal non-superiority of non-surgical treatment for calcaneal fractures.
Further research with appropriate patient selection is needed to definitively compare surgical and non-surgical interventions for calcaneal fractures.