UK HeFT

Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial

Griffin D, Parsons N, Shaw E, et al. BMJ (Clinical research ed.) 2014 · PMID 25059747 · doi:10.1136/bmj.g4483

Question

Does open reduction and internal fixation of displaced intra-articular calcaneal fractures improve outcomes compared with non-operative care?

Design

Pragmatic multicentre assessor-blinded RCT in 22 UK tertiary referral hospitals (UK Heel Fracture Trial).

Patients

Adults with closed, displaced intra-articular calcaneal fractures.

Intervention

Open reduction and internal fixation

Comparison

Non-operative management

Primary outcome

Kerr-Atkins score at 2 years

Key result

There was no significant difference in Kerr-Atkins score at 2 years, and the operative group had more complications and reoperations.

Limitations

Relatively small sample; did not test newer minimally invasive or sinus tarsi approaches; some surgeons had limited caseload.

Impact on practice

Most displaced intra-articular calcaneal fractures in the UK can be managed non-operatively, with surgery reserved for selected cases.