Abstract
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.
