Comparative study of operative and non operative management of intra- articular calcaneal fractures – a prospective study

Introduction: Calcaneum is the most frequently fractured tarsal bone. These fractures result in long term disability with potential economic impact on the patient. Historically treatment of intra articular calcaneum fractures has varied from non-operative management with or without closed reduction to open reduction with internal fixation by various surgical approaches to primary Arthrodesis. In the past two decades with advent of CT scan, better implants and improved methods of fixation Operative treatment has now gained much popularity.
Aim of the Study: The aim is “To compare the results of operative and nonoperative treatment of intra -articular calcaneal fractures”.
Materials and Methods: The study included 40 patients of intra articular calcaneal fractures admitted in RMMCH from June 2015 to September 2017.Twenty patients with intra articular calcaneum fractures treated by non surgical method and Twenty patients treated surgically by percutaneous K- wire fixation, percutaneous cannulated cancellous screw fixation or by open reduction and internal fixation using locking plates with follow up of 6 months. The fractures were classified on the basis of X–Ray findings tongue type or joint depression type and by Computed Tomography (CT) findings as Sanders type I to IV. The patients were evaluated by Modified Maryland Foot Score, with excellent defined as 90 - 100 points, good as 75 – 89 points, fair as 50 – 74 points and poor as <50 points.
Results: In Non surgical management Excellent Modified Maryland Foot Score was achieved in 6 patients, Good in 4, Fair in 3 and poor in 7 patients. In Surgically treated patients Excellent Modified Maryland Foot score was achieved in 13 patients, good in 4, fair in 2 and poor in 1 patient.
Conclusion: Surgical treatment of intra-articular calcaneal fractures using various modalities like K-Wires, cannulated cancellous screws or by locking compression plate has better functional outcome than non surgical cases. Good timing of surgery is of paramount importance to avoid early complications. Reconstruction of subtalar anatomy prevents subtalar arthritis & maintains the foot biomechanics.