Closed Reduction vs ORIF vs Non-Operative Study of intra-articular calcaneal fractures.

Calcaneal fractures are a disabling injury and optimal treatment has yet to be determined. Three meta-analyses1-3 on four RCT’s, one prospective cohort study and three retrospective studies showed a trend towards overall improved outcome in patients treated with Open Reduction and Internal Fixation (ORIF), but most studies were clearly powered for specific outcomes and used non-comparable outcome scores.
The outcome after percutaneous treatment has not been studied in a randomised trial.
Considering the above there is a need for a level-2 study comparing the different treatment modalities of ORIF, percutaneous treatment and conservative treatment, which is adequately powered to the most cited disease-specific outcome score: the American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS).
This study aims to demonstrate a clinically significant difference of 20 points using the most cited and clinically relevant American Orthopedic Foot and Ankle Society hindfoot score (total 100 points) after 2 and 5 years.
ORIF, percutaneous reduction and fixation and conservatively treated patients will be compared in an adequately powered, multicenter randomized controlled trial with 3 treatment arms. Clinical outcome will be measured using the AOFAS score, standard physical exam and radiographic criteria after 2 and 5 years.

Percutaneous, ORIF and conservative treated of displaced intra-articular calcaneal fractures have a similar outcome as measured with the AOFAS (American Orthopaedic Foot and Ankle Society) score.

This study will randomise between: 1. the percutaneous, distraction, technique according to Forgon and Zadravecz, 2. Open Reduction and Internal Fixation via a lateral approach, and 3. conservative treatment.