Comparative study of operative versus nonoperative management of intra-articular calcaneum fractures

Abstract

Purpose: The treatment of intra-articular fractures of the calcaneum remains controversial. There is no consensus in the current literature regarding the optimal treatment of intra-articular fractures of the calcaneum. In the current study, we intend to compare the outcome of operative and conservative management for intra-articular calcaneum fractures based on the objective criteria, i.e., restoration of Bohler's angle, subtalar range of motion, and subjective criteria such as pain, return to work, return to physical activity, and change in shoe wear. Materials and Methods: This retrospective cum prospective study was conducted in a government hospital at Patna, Bihar, during the period extending from April 2016 to March 2019. Twenty-four patients with 25 intra-articular calcaneum fractures were included in the study. The outcome of conservative and operative management was compared using the Creighton-Nebraska Health Foundation Assessment Score (C-N scoring system). Pretreatment and posttreatment (at follow-up) Bohler's angle were also compared. Results: Restoration of the Bohler's angle was better with operative management as compared to conservative management. In our study, the results of type I fractures managed conservatively had a better outcome than those of displaced fractures and the difference was statistically significant. Furthermore, type II and type III fractures had a better outcome with operative management, but the difference was not statistically significant. In type IV fractures, operative management was significantly better than conservative management. A significant correlation was seen between the posttreatment Bohler's angle and C-N scores. Conclusions: Conservative management has better functional outcome for undisplaced fractures. For 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.