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- Essai clinique NCT01615744
Surgical vs Conservative Treatment of Displaced Intra-articular Calcaneal Fractures: A Prospective RCT
Surgical vs. Conservative Treatment of Displaced Intra-articular Calcaneal Fractures: A Prospective, Randomized, Controlled Multicenter Trial
Between 1994-98 5 hospitals in Stockholm investigated calcaneal fractures in a randomised study.
82 patients were included and randomized either to non-surgical treatment or surgical management with extensile lateral approach and reduction with Internal fixation (ORIF) The patients were followed and investigated at fixed intervals 2 weeks, 8 weeks, 3 months and 6 months for clinical review. At 1 year and 8-12 years (mean 10 years) post-injury.
Both clinical radiological data were collected and several scores were used. The primary outcomes scores used were SF-36 and VAS score.
The results after 1 year and mean 10 years are presented.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
The study was approved by the local ethical committee. Seven trauma orthopaedic surgeons in five hospitals in Stockholm were recruited in this RCT, which was conducted between 1994 and 1998. Patients presented with > 2mm DIACFs verified by axial and coronal computerized tomography (CT) scan were considered for inclusion. Exclusion criteria included peripheral neuro-vascular disease (signs and symptoms of ischemia or neuropathy), open fractures, uncontrolled diabetes mellitus and medical contra-indications to surgery.
All centers used the same study protocol. Demographic data were obtained from the patients, as they deemed eligible to participate in the study. Informed consent was obtained from each patient. Randomization was carried out by sealed opaque envelope to choose surgical vs. conservative treatment.
The surgical treatment was carried out within 2 weeks post-injury when the local soft tissue swelling subsided. Surgery included open reduction using the lateral extensile approach according to Benirschke (ref) and manipulation of the fragments as described by Soeur and Remy (ref) to achieve anatomical reduction, which then was fixed by screws, reconstruction plates or calcaneal plates. Using bone grafts was left to the judgment of the surgeon. Postoperatively, plain X-ray and CT scan were used to evaluate the quality of fracture reduction. Sex week's non-weight bearing was advocated for all patients. Range-of-motion exercises were allowed during this period. Thereafter, the patients had a standardized physiotherapy regimen with full weight bearing.
The conservative treatment included rest, elevation and non-weight bearing. Early range-of-motion exercises were encouraged as tolerated. After 6-8 weeks weight bearing was allowed and shoe modification was provided to those who had hind foot deformities.
No patients were managed with impulse compression therapy.
Patients of both groups were followed-up by treating surgeons at 2 weeks, 8 weeks, 3 months and 6 months for clinical review. At 1 year and 8-12 years (mean 10 years) post-injury, all patients were evaluated by unbiased surgeons who were not involved in the treatment of the patients and they completed the following questionnaires:
- Primary outcome measures: visual analogue scale (VAS) scoring devised and tested by Hildebrand et al (ref) and a self-administrated general health outcome form (SF-36) for physical and mental health.
- Secondary outcome measures: VAS at rest and on weight bearing (0-10), the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale and the Olerud-Molander (OM) score.
The investigators divided each group into two subgroups, younger and older than 50 years to determine if the results of the outcome measures at 1 year would differ according to the age of the patients.
During controls, clinical evaluation was carried out to measure the ankle joint and subtalar joint range of motion and the length and width of the hind foot. The contra-lateral non-fractured foot was used for comparison. Shoe problems, the outcome of any eventual postoperative/post-injury complications and workers´ compensation were documented. Radiological follow-up with axial and coronal CT scan was done at the 1 year and 3 years visits.
Statistical analysis The SPSS program version 18.0 for personal computers (Chicago, Illinois) was used for data analysis. The variables of interests were analyzed to determine the differences using bivariate comparisons. The means with standard deviation (SD) were measured. The Mann-Whitney test was used for non-parametric data while two-sample t-test was used for parametric data. A p value of <0.05 was considered significant.
Type d'étude
Inscription (Réel)
Contacts et emplacements
Lieux d'étude
-
-
-
Stockholm, Suède, 11486
- Stockholms Fotkirurgklinik, Sophiahemmet
-
-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
Méthode d'échantillonnage
Population étudiée
La description
Inclusion Criteria:
- Patients presented with > 2mm DIACFs verified by axial and coronal computerized tomography (CT) scan were considered for inclusion
Exclusion Criteria:
- Peripheral neuro-vascular disease (signs and symptoms of ischemia or neuropathy), open fractures, uncontrolled diabetes mellitus and medical contra-indications to surgery.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
Cohortes et interventions
Groupe / Cohorte |
Intervention / Traitement |
---|---|
Surgical ORIF calcaneal fx
|
Lateral approach through extensile lateral incision ( Benirschke), Reduction ( Soeur et Remy) and internal fixation with lateral plating with or without bone graft
Autres noms:
|
Conservative treatment calcaneal fx
|
Early active exercises and elevation to decrease swelling
Autres noms:
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
SF-36
Délai: 1 year and 10 years post injury
|
The investigators anticipate that there might be a change over time and want to investigate and describe it
|
1 year and 10 years post injury
|
VAS-score (calcaneal fractures) /Hildebrand, Buckley
Délai: 1 year and 10 years post injury
|
The investigators anticipate that there might be a change over time and want to investigate and describe it
|
1 year and 10 years post injury
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
VAS of pain at rest and exertion
Délai: 2 weeks,6 weeks,12 weeks,1 year, 3 years and 10 years post injury
|
The investigators anticipate that there might be a change over time and want to investigate and describe it
|
2 weeks,6 weeks,12 weeks,1 year, 3 years and 10 years post injury
|
AOFAS hindfoot scale
Délai: 1 year and 10 years post injury
|
The investigators anticipate that there might be a change over time and want to investigate and describe it
|
1 year and 10 years post injury
|
Olerud-Molander score
Délai: 1 year and 10 years post injury
|
The investigators anticipate that there might be a change over time and want to investigate and describe it
|
1 year and 10 years post injury
|
Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: Per-Henrik Aagren, MD, Consultant Orthopaedic Surgeon
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- CalcanealfxRCT
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