Should calcaneal fractures be treated surgically? A meta-analysis

A MEDLINE search from 1980 through 1996 revealed 1845 articles dealing with calcaneal fractures. Six of these articles that compared operative versus nonoperative treatment for displaced calcaneal fractures met the minimum criteria for inclusion in a meta-analysis. A statistical summary of information across the six articles revealed a trend for surgically treated patients to be more likely to return to the same type of work as compared with nonoperatively treated individuals. There also was a trend for nonoperatively treated patients to have a higher risk of experiencing severe foot pain than did operatively treated patients. Unfortunately, none of the other outcomes could be summarized formally across studies using statistical techniques because of variability in reporting across studies. Although the tendency was always for operatively treated patients to have better outcomes (reaching statistical significance in some of the articles), the strength of evidence to recommend operative treatment for displaced intraarticular calcaneal fractures remains weak. A large prospective randomized controlled trial should be able to answer this question.