A comparison of operative versus non-operative management of displaced intra-articular fractures of the os-calcis

T.L. Walker, S. Akhtar, A.A. Henderson

Introduction: The os-calcis is the most common tarsal bone to fracture. It can lead to a debilitating arthritis and has considerable socio-economic implications. In the literature there is great debate as to whether operative or non-operative management has a better outcome. Previous smaller case series report improved results from surgery whereas the one randomised trial showed no overall benefit from surgery. However sub-group analysis identified patients that had a better outcome with operative management. Results from the UK heel fracture trial are awaited. We present a 5 year series from a single centre, single surgeon that includes 143 fractures. There are currently no comparable published data.

Methods: We reviewed 143 intra-articular fractures of the os calcis. All fractures were evaluated using CT scans and classified according to Sanders system. The functional outcome of Sanders type 2 fractures were evaluated using Atkins scoring system. Evaluation took place annually between 2 and 7 years post injury. A comparison was made between type 2 fractures treated operatively and those treated non-operatively.

Results: 143 patients with Type 2 sanders fractures were reviewed from 2 years to 7 years post injury. 109 patients were treated operatively, 34 patients were treated non-operatively. The mean score for 2 part fractures treated operatively was 76.52 ( range 73-78 SD +/- 2.9 ). The mean score for 2 part fractures treated non-operatively was 60.88 (range 59-69 SD +/- 5.76). The mean difference in scores was 15.64. This was stastiscally significant. CI (11.4 - 19.24) P < 0.05.

Conclusion: Data from our single centre, single surgeon series showed that patients with 2 part os calcis fractures have significantly better functional outcome than those managed non-operatively. This is in keeping with smaller data sets in the published literature.