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The UK Heel Fracture Trial was a pragmatic multicentre randomized study evaluating open reduction and internal fixation against nonoperative management for displaced intra-articular calcaneal fractures. The trial addressed a central orthopaedic controversy: whether reconstructing the subtalar joint surgically improves patient-centred outcomes enough to justify the wound and infection risks of an extensile approach. At long-term follow-up, the overall functional results did not demonstrate a clear benefit from ORIF. The study therefore helped shift the discussion from radiographic perfection toward the balance between functional benefit and treatment morbidity. Not every fracture pattern can be managed identically, and the trial excluded some patients with marked deformity or other indications for surgery. For clinicians, the practical takeaway is to reserve operative treatment for patients in whom the expected mechanical benefit is substantial. Soft-tissue assessment, fracture morphology and patient factors are as important as the CT appearance. The paper remains highly relevant to contemporary foot-and-ankle practice because it demonstrates that a technically successful operation is not necessarily the same as a better long-term patient outcome.
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The UK Heel Fracture Trial was a pragmatic multicentre randomized study evaluating open reduction and internal fixation against nonoperative management for displaced intra-articular calcaneal fractures. The trial addressed a central orthopaedic controversy: whether reconstructing the subtalar joint surgically improves patient-centred outcomes enough to justify the wound and infection risks of an extensile approach. At long-term follow-up, the overall functional results did not demonstrate a clear benefit from ORIF. The study therefore helped shift the discussion from radiographic perfection toward the balance between functional benefit and treatment morbidity. Not every fracture pattern can be managed identically, and the trial excluded some patients with marked deformity or other indications for surgery. For clinicians, the practical takeaway is to reserve operative treatment for patients in whom the expected mechanical benefit is substantial. Soft-tissue assessment, fracture morphology and patient factors are as important as the CT appearance. The paper remains highly relevant to contemporary foot-and-ankle practice because it demonstrates that a technically successful operation is not necessarily the same as a better long-term patient outcome.
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