Conservative versus Surgical Treatment for Displaced Fracture of the Medial Process of the Calcaneal Tuberosity

Abstract

Purpose To compare the outcome following conservative or surgical treatment for displaced fracture of the medial process of the calcaneal tuberosity. Methods 14 men and 4 women aged 20 to 44 years chose to undergo conservative (9 feet) or surgical (10 feet) treatment by a single surgeon for closed displaced fracture of the medial process of the calcaneal tuberosity. The injury mechanism was a fall from a height of <1.5 m; the mean time from injury to treatment was 3 (range, 1–7) days. Conservative treatment comprised immobilisation in a plaster cast. Surgical treatment involved fixation with a half-thread cannulated screw for large fragments (in 6 feet) or a mini-plate for comminuted fragments (in 4 feet). At the final follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was evaluated. Results The conservative and surgery groups were comparable in terms of age, gender, and fracture displacement. The mean follow-up duration was 20 (range, 14–24) months. All patients had bone union; none had implant loosening or breakage. One patient with surgical treatment developed skin numbness at the medial aspect of the heel that resolved following neurotrophic drug treatment for 3 months. The surgery group achieved earlier full weight-bearing (5.8 vs. 7.5 weeks, p<0.001) and return to work (5.9 vs. 8.2 weeks, p=0.048), but comparable AOFAS score (89.0 vs. 88.2, p=0.4). Conclusion Surgery for displaced fracture of the medial process of the calcaneal tuberosity enabled earlier full weight-bearing and return to work but comparable AOFAS score.