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Computed tomography (CT) scan is helpful in identifying bone deformities resulting from intraarticular calcaneal fractures such as loss of calcaneal height, increased width of calcaneal wall, and disruption of the posterior articular facet. The aim of this study is to compare the result of spiral CT scan assisted analysis of calcaneum anatomy, articular congruity and onset of arthritic changes with intraarticular calcaneal fractures in patients treated either operatively or conservatively. Material and methods: Twenty patients were recruited, 9 in the operative group and 11 in the conservative group. CT scan of the injured foot and ankle were taken followed by detailed functional assessment based on the American Orthopaedic Foot & Ankle Society Score (AOFAS) and Maryland Foot Score (MFS). Calcaneal height, length and width were measured to assess the functional and radiological outcome in the patients. The presence and severity of arthritic changes were reviewed. Results: The calcaneal height, length and width were relatively restored in the operative group compared to the conservative group. A significantly larger posterior articular facet step was seen in the conservative group with accelerated onset and significantly higher (p = 0.001) grade of arthritis in the subtalar joints apart from having significantly higher (p = 0.038) incidences of calcaneocuboid arthritis. The operative group showed significant improvement (p = 0.009) in functional outcome based on MFS scoring system. Conclusions: Operative intervention with calcaneal locking plate provides good framework for near anatomical bone healing and redistributes the mechanical forces on the foot resulting in improved pain, function and alignment in patients.

3D CT scan assessment of the outcome of displaced intra-articular calcaneal fractures: operative versus non-operative treatment