Description
In this informative medical presentation, Anish Amin, a Trauma and Orthopaedic Surgeon from the Royal Infirmary of Edinburgh, discusses the treatment of calcaneal fractures. He outlines three approaches: conservative care, open reduction internal fixation (ORIF), and percutaneous techniques, emphasizing the historical context and evolution of these treatment methods over the last century. Anish references early attempts at non-operative treatment and highlights the limitations of these approaches.
He presents evidence from recent randomized controlled trials that showed no significant difference between operative and non-operative treatments at the two-year mark while synthesizing the perspectives of both optimistic and pessimistic viewpoints towards these findings. Additionally, he explains the nuances of using the Sinus tarsi approach, which allows for a minimally invasive technique to correct heel varus and restore foot shape without extensive incisions.
A key point made is the struggle with anatomical reduction of the posterior facet, and while both surgical methods can achieve this, the evidence suggests a higher consistency with ORIF. Anish also compares wound complications, noting that percutaneous techniques generally result in fewer issues due to smaller incisions. He addresses patient-reported outcomes, indicating a lack of clarity in the effectiveness of the Sinus tarsi approach compared to open techniques.
Concluding, he acknowledges the challenges of foot shape restoration through both operative methods while supporting the need for ongoing improvements and innovations in treating calcaneal fractures. He articulates the necessity for a critical evaluation of both non-operative and percutaneous treatments going forward, inviting contemplation on the future of calcaneal fracture management.