A COMPARATIVE STUDY OF OPERATIVE MANAGEMENT WITH CONSERVATIVE MANAGEMENT OF CALCANEUM FRACTURES

Abstract

Background Calcaneal fractures account for approximately 2% of all fractures, with displaced intra-articular fractures comprising 60% to 75% of these injuries1. Studies in fracture patterns, soft-tissue management, and outcomes of calcaneal fractures have led to the debate on the optimal management of calcaneal fractures. Several Prospective randomized studies have shown equivocal outcomes with operative and nonoperative treatment. However, recent trends in the literature suggest that restoration of physiologic parameters of length, height, and alignment of the calcaneus may lead to better long-term results. Initial studies using extensile approaches showed higher rates of wound complications with operative treatment; however, recent studies have shown lower complication rates with sinus tarsi and other minimally invasive techniques. Regardless of the mode of treatment, calcaneal fractures are associated with numerous complications and guarded outcomes with signicant longterm morbidity. Objectives 1. To comparatively study the functional outcome of calcaneum fracture when treated conservatively with that of operative management 2. To study complication when treated conservatively with that of operative management METHODS Study was conducted in Department of Orthopedics, Basaveshwara Teaching and General Hospital, Kalaburagi.30 patients with 30 calcaneum fracture were included in the study. Outcome of conservative and operative management was compared using Creighton Nebrasaka health foundation scoring system. Pre treatment and post treatment (at follow up) Bohler's angle was also compared. Chisquare analysis and paired t test was done to compare the results of conservative and operative management. Restoration of the RESULTS Bohler's angle was better with operative management as compared to conservative management. Functional outcome for type I fractures was better with conservative management. For type II and type III functional outcome was relatively better with operative management for type IV fractures the outcome was signicantly better with operative management. A signicant correlation was seen between the post treatment Bohler's angle and C-N scores. Interpretation & Conclusion Conservative management has better functional outcome for undisplaced fractures. Where as displaced and comminuted fractures anatomical reduction and restoration of Bohler's angle is very important. Bohler's angle has a prognostic importance and correlates well with the functional outcome