Conservative versus surgical treatment for displaced fracture of the medial process of the calcaneal tuberosity.

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 halfthread 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.