Aim: 1. To assess the role of the CT scan in management of intra-articular fractures of the calcaneum. 2. Does the scan makes any difference to the management decision, obtained from assessing the plain radiograph?.

Methodology: This study involved 24 patients with intra-articular fracture of the calcaneum who had both a plain radiograph and a CT scan as a part of their assessment. Three consultants who were blinded to the actual management and names of the subjects were independently asked to grade the radiographs and CT scans, as operative or non-operative, on different occasions. The data was matched to the actual management and was subjected to statistical analysis.

Results: The data was non-parametric and related. The SIGN test was used to analyse the agreement between the three observers and if the decisions made in each of the groups were significantly different from the actual management. There was no statistically significant difference, between the management decision from the radiographs or CT and the actual management.

The change in management that the CT scan brought about was also assessed for each of the observers using the McNemars test. The CT scan did not make any significant difference to the decision made based on the plain radiographs, on whether to operate or not.

A Cochran Q test used to assess the variability of the decisions, showed that there was more inter-observer variability in decision making, using the CT based assessment (Q=9.50, p=0.009) as compared to plain radiographs (Q=3.84, p=0.14).

Conclusion: We conclude that, the CT scan should only be requested when a decision is made to operate on the fracture, based on plain radiographs. This may help with pre-operative planning of fracture fixation. It does not have to be obtained as a routine to assess all intra-articular fractures of the calcaneum.

CT- scan as an management tool is being used extensively in managing calcaneal fractures. We set out to see if a CT-scan makes any difference to the management plan as obtained by looking at the plain radiograph. We also looked at the correlation with the actual management.

Methodology: This was a retrospective study involving 24 patients with fracture of the calcaneum. These patients had both a plain radiograph and a CT- scan to help decide on management. The actual management that each of these patients had was documented. Three consultants who were blinded to the actual management and names of the subjects were independently asked to grade the radiographs, as operative or non-operative. They were then similarly, asked to decide on operation or no-operation based on blinded CT- scans. The data obtained from the three observers were compared to the actual management and were subjected to statistical analysis.

Results: As the data was categorical and matched, the Mcnemars test was used to test the association between the management plan obtained from the radiographs and the management plan obtained from the CT scans, for each consultant. They were also compared with the actual management. The statistical analysis showed that there was no statistically significant association between the management decision obtained from the radiographs and the CT san, for all three observers. Radiograph and CT scan based management decisions also did not correlate with the actual management.

Conclusion: The CT scan should only be done when a definite decision is made to operate on a patient, based on plain radiographs. Calcaneal fractures which are decided not to operate, based on X rays, should not have a CT scan as a routine as it provides no valuable additional information.