Irish Journal of Medical Science

, Volume 171, Issue 3, pp 155–157 | Cite as

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

  • B. S. Thornes
  • A. L. Collins
  • M. Timlin
  • J. Corrigan
Original Paper



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


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


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.


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.


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.


Internal Fixation Irish Journal Calcaneal Fracture Fracture Grade Physical Status Classification 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    O’Farrell DA, O’Byrne JM, McCabe J, Stephens MM. Fractures of the os calcis: improved results with internal fixation.Injury 1993; 24: 263–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Crosby LA, Fitzgibbons TC. Open reduction and internal fixation of type II intra-articular calcaneal fractures.Foot Ankle Int 1996; 17: 253–8.PubMedGoogle Scholar
  3. 3.
    Rodriguez-Merchan EC, Galindo E. Intra-articular displaced fractures of the calcaneus. Operative vs. non-operative treatment.Int Orthop 1999; 23: 63–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Leung KS, Chan WS, Shen WY et al. Operative treatment of intra-articular fractures of the calcaneum. Medium-term results.J Bone Joint Surg 1993; 75-B: 196–201.Google Scholar
  5. 5.
    Thordarson DB, Krigger LE. Operative vs. non-operative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial.Foot Ankle Int 1996; 17: 2–9.PubMedGoogle Scholar
  6. 6.
    Parmar HV, Triffit PD, Greg PJ. Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study.J Bone Joint Surg 1993; 75-B: 932–7.Google Scholar
  7. 7.
    Kundel K, Funk E, Brutscher M, Bickel R. Calcaneal fractures: operative versus non-operative treatment.J Trauma 1996; 41: 839–45.CrossRefPubMedGoogle Scholar
  8. 8.
    Buckley RE, Meek RN. Comparison of open versus closed reduction of intra-articular calcaneal fractures.J Orthop Trauma 1992; 6: 216.CrossRefPubMedGoogle Scholar
  9. 9.
    Jarvholm U, Korner L, Thoren O, Wiklund LM. Fractures of the calcaneus. A comparison of open and closed treatment.Acta Orthop Scand 1984; 55: 652–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intra-articular calcaneal fractures.Clin Orthop Rel Res 1995; 290: 87–95.Google Scholar
  11. 11.
    Crosby LA, Fitzgibbons T. Computerised tomography scanning of acute intra-articular fractures of the calcaneus: a new classification system.J Bone Joint Surg 1990; 72A: 852–9.Google Scholar
  12. 12.
    Essex-Lopresti P. The mechanism, reduction, technique and results in fractures of the os calcis.Br J Surg 1952; 39: 395–419.CrossRefPubMedGoogle Scholar
  13. 13.
    Soeur R, Remy R. Fractures of the calcaneus with displacement of the thalmic portion.J Bone Joint Surg 1975; 57-B: 413–21.Google Scholar
  14. 14.
    Shepard GJ, Sochart D, Christodoulou L, Doyle J. The effect of ongoing litigation on outcome scores following open reduction and internal fixation of the calcaneum.Injury 1998; 29: 499–501.CrossRefPubMedGoogle Scholar
  15. 15.
    Frieman BG, Fenlin JM. Anterior acromioplasty: effect of litigation and workers’ compensation.J Shoulder Elbow Surg 1995; 4: 175–81.CrossRefPubMedGoogle Scholar
  16. 16.
    Kay NR, Morris-Jones H. Pain clinic management of medico-legal litigants.Injury 1998; 29: 305–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Blake C, Garrett M. Impact of litigation on quality of life outcomes in patients with chronic low back pain.Ir J Med Sci 1997; 166: 124–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Owens WD, Felts JA, Spitznagel EL. ASA physical status classifications: a study of consistency of ratings.Anesthesiology 1978; 49: 239–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Kerr PS, Prothero DL, Atkins RM. Assessing outcome following calcaneal fracture: a rational scoring system.Injury 1996; 27: 35–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2002

Authors and Affiliations

  • B. S. Thornes
    • 1
  • A. L. Collins
    • 1
  • M. Timlin
    • 1
  • J. Corrigan
    • 1
  1. 1.Department of Orthopaedic SurgeryWaterford Regional HospitalIreland

Personalised recommendations