Outcome of calcaneal fractures treated operatively and non-operatively. The effect of litigation on outcomes
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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.
KeywordsInternal Fixation Irish Journal Calcaneal Fracture Fracture Grade Physical Status Classification
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