Objective To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures.Design Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial).Setting 22 tertiary referral hospitals, United Kingdom.Participants 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment. Main outcome measuresThe primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat.Results 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group v 65.7 in non-operative group; adjusted 95% confidence interval of difference −7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8).Conclusions Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures.Trial registration Current Controlled Trials ISRCTN37188541.

A new spiral linking technique for tendon repair in which one end of the tendon is spiralled around the other end has been developed. Using pig trotter extensor tendons, the Pulvertaft weave technique was compared with this new technique. Twenty-five repairs using each technique were tested by tensile loading with an Instron testing machine. The spiral linking technique matched the strength of Pulvertaft method: the mean peak loads were 102 and 105 N, respectively. The Pulvertaft weave was stiffer than the spiral linking technique: mean stiffness of 11.1 and 6.7 N/mm, respectively. The spiral linking technique also absorbed considerably more energy: energy absorbed prior to failure to 90% of peak load, 1.75 and 1.13 kN mm, respectively. In conclusion, the spiral linking technique appears as strong as the Pulvertaft weave and we believe it is easier to perform.

Avulsion fractures of the metacarpophalangeal joints are uncommon and there are few reports on their outcome after conservative treatment. We treated seven such patients with fracture fragment sizes between 10% and 25% of the width of the articular surface on the radiograph by early active mobilisation in neighbour strapping. The outcome of treatment was assessed at a mean follow-up of 57 (range 8-94) months. The mean visual analogue pain score was 0.6 (range 0-2) and the mean visual analogue function score was 9 out of 10 (range 6-10). The mean DASH score was 3.1 (range 0-12.5). All but one patient had normal grip strength and a full range of finger movement. We believe that the majority of avulsion fractures of the metacarpophalangeal joint can be managed successfully without surgery.