Calcaneal Fracture in 2022 - Lecture at the Royal Society of Medicine Trauma Symposium 2022

Description

The video covers the management of calcaneal fractures in 2022, addressing controversies around surgical versus non-surgical treatment options, particularly in light of the significant study published in the BMJ on the subject. The speaker emphasizes how this study has impacted prevailing beliefs in the foot and ankle community, highlighting that surgery for calcaneal fractures may not provide the expected benefits, particularly in cases reaching equipoise—a condition where a surgeon is indifferent between two treatment options.



Key points discussed include:

- The implications of the heel fracture trial, which suggested no clear benefit from surgical intervention;

- Concerns regarding study inclusivity, as many patients who would traditionally require surgery were excluded due to equipoise;

- The importance of considering patient outcomes over time, noting continued improvement even four years post-fracture, which could deter the urgency for surgical options like subtalar fusion.



The speaker offers insights into evolving surgical techniques such as the sinus tarsi approach for minimal incision and reduced infection rates. This technique showed reduced operative times and outcomes similar to traditional methods, yet with lower complication rates.



He also discusses specific challenges with fracture classifications and the importance of timely surgical intervention in case of severe types, detailing his practical approach to restoring alignment and function in various scenarios, including complex fractures and soft tissue injuries.



In conclusion, the present-day management of calcaneal fractures is cautioned to balance the risks of surgery against potential long-term outcomes, emphasizing the importance of individualized patient care and modern minimally invasive techniques.

DOI: 10.1302/3114-221855

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