ORIF for fractured calcaneus?

Description: Bruce J. Sangeorzan, MD, is associate professor of orthopaedic surgery, University of Washington, Harborview Medical Center. The literature is full of suggestions for the treatment of calcaneus fractures. Yet it is possible to read hundreds of papers devoted to calcaneus fractures and still not know which to treat or how to treat them. Closed treatment with early motion is a moderately successful treatment that remains the standard to which new treatments must be compared. However, failure to seek alternatives to closed treatment would have us accept impairments beyond a standard that would be acceptable in other intra-articular weight-bearing joints. As in most orthopaedic conditions, no valid prospective randomized trial has been completed. In the absence of such a trial, we base treatment decisions on training, experience, retrospective studies and, most worrisome, the vagaries of third-party dictum.