Outcome of calcaneal fractures treated operatively and non-operatively. the effect of litigation on outcomes

Ir J Med Sci. Jul-Sep 2002;171(3):155-7. doi: 10.1007/BF03170505.

Abstract

Background: The optimum management of calcaneal fractures is controversial. These injuries are frequently associated with compensation litigation, which effects the outcome.

Aims: To assess the outcome of operatively and conservatively managed intra-articular calcaneal fractures and to examine the effect of compensation litigation on outcome.

Methods: This was a retrospective study of calcaneal fractures from a single regional trauma unit, with management decided by the admitting consultant surgeon's preference. Fifty-four patients (33 operative, 21 conservative) with an average follow-up of 40 months (range 14-78 months) were reviewed. Sixteen patients (30%) were pursuing a compensation case resulting from the injury.

Results: Despite similar fractures, medical co-morbidity and trauma energy, significantly worse outcome scores were seen in litigants (p < 0.0001). Footwear fitting problems were greater in litigants. Time off work was more than twice that of non-litigants (14.5 vs 6 months, p < 0.01). Results were similar between the operative and non-operative groups in terms of functional score, footwear problems and time off work.

Conclusions: Litigation was the major determinant of outcome following calcaneal fracture repair; highlighting the unreliability of subjective evaluation in determining outcome in the face of litigation. No subset of patients appeared to significantly benefit from internal fixation of their fracture.

MeSH terms

  • Absenteeism
  • Calcaneus / injuries*
  • Case-Control Studies
  • Fracture Fixation, Internal*
  • Fractures, Bone / surgery
  • Fractures, Bone / therapy*
  • Humans
  • Middle Aged
  • Retrospective Studies
  • Shoes
  • Treatment Outcome
  • Workers' Compensation* / legislation & jurisprudence*