Calcaneal fractures: operative versus nonoperative treatment

The purpose of this report is to compare the late results after operative and nonoperative treatment of intra-articular calcaneal fractures.

From 1982 to 1992 we treated 250 calcaneal fractures of which 193 were intra-articular. Because of a change in operative indication, most fractures were treated nonoperatively before 1989 and operatively thereafter. Follow-up was possible at an average of 5.1 years for 124 intra-articular calcaneal fractures. Out of these, two groups of 33 nonoperatively and 30 operatively treated cases were formed matching each other with regard to prognostic parameters. Results were assessed by a clinical score considering pain, gait, footwear, and return to work. Pre- and postoperative tuber joint angle measurements were evaluated for their prognostic significance.

In this series of patients, the only statistically significant advantage of operative therapy was concerning return to work. There was no correlation between tuber joint angle and end results. Only when the extremes of the spectrum (nonoperative and operative cases with tuber joint angle < 0 degrees vs. > 25 degrees) were tested against each other was a significant advantage in the group with near normal joint angles found. Thus, open reduction and internal fixation of intra-articular calcaneal fractures can only be expected to benefit those patients with near anatomic reconstruction.