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. 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.Introduction:
Methods:
There are a multitude of studies internationally that have considered the rates of redislocation of shoulders, where, after first time anterior dislocation, initial management has consisted of an internal rotation sling immobiliser or no immobility. The majority of these have indicated poor results. This is in comparison with recurrence rates of dislocation, post shoulder stabilisation (arthroscopic or open), after first time anterior dislocation, which have demonstrated excellent results. The question remains, is there a non-operative alternative that will give similarly good results for these patients. A selection criteria was set up for use of the external rotation brace for first time anterior dislocators. Thirty-five patients were used that fit the criteria and were able to be followed over time. A physiotherapy program was initiated at the two-week stage in combination with clinic reviews. We encouraged use of the brace for six weeks in total, with removal only for hygiene purposes. At two years, post first time anterior dislocation, patients were reviewed clinically and a quick DASH score performed. Any recurrence of dislocation was recorded and an MRI was also undertaken to show residual injury. The compliance with the brace and physiotherapy program were excellent, with only one reported redislocation, during this period, in the 31 patients that were followed up. The majority of patients were functioning at predislocation levels at review and no one had required surgical intervention for instability. Quick-Dash results were also very good, with a vast majority scoring less than 2/100 level of disability. The external rotation brace with a Physiotherapy program is an excellent alternative to early shoulder stabilisation for first time anterior dislocators.Conclusion
