Fractures of the calcaneus. A comparison of open and closed treatment

Twenty patients with displaced intraarticular fractures of the calcaneus treated by open reduction and early postoperative motion exercises were compared after 2-12 years with 19 patients with similar fractures treated closed. The two groups were comparable regarding follow-up time, age, sex-distribution, and preinjury occupation. The pain and disability were almost equal in both groups. Three patients in both groups had marked residual symptoms, and equally many had negligible symptoms. The operated patients had less reduced subtalar motion, better ability to jump and run, longer walking distances on uneven surfaces, and reduced forward tilting of the lateral part of the posterior articular surface, but only a slightly improved Böhler angle. Nine operated and eight conservatively treated patients had radiographic signs of osteoarthrosis. Open reduction of the intraarticular fracture of the calcaneus may provide stability, allowing early motion and eventually improved subtalar function. However, postoperative complications are common, and the overall end results of open and closed treatment are almost equal. Primary operation of the fractured calcaneus should therefore rarely be indicated.