Last month, Reuters published an article comparing the outcome of surgery versus non-operative care when it comes to heel bone fractures. In their article, researchers claim “surgery by open reduction and internal fixation in patients with typical fractures of the heel bone didn’t improve outcome compared with non-operative care.”
They went on to chastise operative care for heel fractures, saying:
- “[There was] no symptomatic or functional advantage after two years.”
- “The risk of complications was higher after surgery.”
- “We had anticipated benefit in at least some of these measures, but there were no differences in patient reported general health, quality of life, or ability to return to work. Ranges of movement of the injured hind foot were no different between treatment groups, and even heel width (a commonly suggested reason for surgery, to facilitate shoe fitting) was the same. Walking speed and five different metrics of gait also showed no difference at two years after injury.”
Worst of all, they concluded by saying, “There is no justification to continue with this surgery for closed displaced intra-articular calcaneal fractures without severe displacement. Patients and their surgeons can choose safer but equally effective non-operative care. “
Why They’re Wrong
This study and the research on it is poorly presented, but this is typical of a group trying to please a universal health plan, not trying to fret out the truth in care. In essence. they basically compared an out of date surgical technique to non-surgical technique.
Since 2005, I have not performed an open reduction and internal fixation using the technique described in the article. That surgery has a high rate of wound complications and infection, which they make a particular point in noting. This technique often requires prolonged immobilization in a cast and forces the patient to be non-weight bearing for 10 weeks (just as in non surgical treatment).
Instead, I have been using minimally invasive procedures using one or two small incisions. I achieve the same strength of fixation alignment without any wound problems. Instead of waiting up to three weeks for the skin and the tissues to be ready to handle the insult from the large classical L-shaped incision, surgery can proceed safely within the first week of the injury. Instead of patients placed on their side, the surgery can be done with patients lying supine on their backs, a safer position for anesthesia. Patients are removed from the cast after two weeks and begin weight bearing at six weeks. Their recovery from injury is more than twice as fast, the incision becomes invisible and the pain and swelling are greatly reduced.
When you compare a minimally invasive operation to fully open surgery, the differences are so large you can see why I so vehemently disapprove of this study!
The variety of options for minimally invasive technology have been developed over the last 4-6 years. Studies like this do a discredit to surgery and to surgeons, confuse the public, make insurance communications a hassle at best, and can block the top care for patients at the worst.
I am sure this paper will be discussed at next weeks combined IFFAS/AOFAS: International Federation of Foot and Ankle Societies and American Orthopedic Foot and Ankle Society meeting in Chicago. It’s an honor for the US to host the event. I am excited to go and learn from surgeons around the world. I can’t wait to let my patients benefit from all the shared information.
Related source: Reuters
