Second Look – Clinical News and Views

Displaced intra-articular calcaneal fractures
According to findings in Journal of Bone & Joint Surgery (JBJS) (Aug. 7), surgical treatment may be superior to nonsurgical treatment of displaced intra-articular calcaneal fractures, but only at long-term follow-up. The authors of the prospective, randomized, controlled trial of 42 patients treated surgically and 40 patients treated nonsurgically found that primary and secondary outcome measures did not differ significantly between the two treatment groups at 1-year follow-up. Among the 58 patients available at 8- to 12-year follow-up, there was a trend toward better scores on the patient-reported primary visual analog scale score for pain and function and the physical component of the SF-36 in the surgical group. The prevalence of radiographically evident posttraumatic subtalar arthritis was lower among patients in the surgical group.

Use of lateral wedge orthotics for knee OA
Findings in the Journal of the American Medical Association (JAMA) (Aug. 21) question the efficacy of lateral wedge shoe insoles for the reduction of knee pain associated with medial osteoarthritis. The meta-analysis of 12 trials covering 885 participants, 502 of whom received lateral wedge treatment, found that the use of orthotics did significantly impact pain levels compared to controls, but such impact was generally limited to studies determined to have a greater risk of bias. Studies that compared the use of orthotics against neutral inserts (for improved blinding) consistently demonstrated no significant or clinically important impact from lateral wedges.

The AAOS Clinical Practice Guideline on Treatment of Osteoarthritis of the Knee covers the use of lateral wedge orthotics and can be found at www.aaos.org/guidelines

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