Review of the radiology in randomised controlled trials in open reduction and internal fixation (ORIF) of displaced intraarticular calcaneal fractures

The aim of this study was to assess the radiological evaluation of all pros pective, randomised, controlled trails of displaced intraarticular calcanea l fractures. A systematic review of the literature, of which only three of 296 references were randomised and controlled, were examined in a blinded f ashion. All had preoperative coronal CT for Sander's classification and use d a lateral surgical approach or conservative treatment. Thordason (15 pati ents/11 controls) used interoperative lateral and axial X-rays. Bohler's an gle increased on average from 11 to 26 degrees (P < 0.001) postoperatively, but decreased (9-8<degrees>) in the conservative group. The posterior face t residual displacement was 1.1 and 4.7 nim, respectively. O'Farrell (12 pa tients/12 controls) showed 8 out of 12 had Bohler's and Gissane's angle par tially or fully restored postoperatively, and not conservatively. Parmar (2 5 patients/31 controls) used preoperative lateral radiographs, but failed w ith CT to grade the postoperative reduction, whilst the conservative group was unaltered. There was no systematic, blinded assessment of the change in radiology by the operative intervention. Overall there was weak evidence t o support ORIF. In conclusion, there are only three randomised, controlled studies involvin g small numbers of patients, which showed improved plain radiographic anato mical alignment, in the postoperative but not conservative group. Further p rospective randomised, controlled trials with independent and blinded asses sment with accurate CT and clinical evaluation will be required before ORIF can be adopted as the best practice. (C) 2001 Elsevier Science Ltd. All ri ghts reserved.