{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:02:53Z","timestamp":1780473773177,"version":"3.54.1"},"reference-count":30,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Orthopaedics"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Management of displaced intra-articular calcaneus fractures remains controversial. While operative techniques are well-described, few large-scale studies have compared long-term outcomes between operative vs nonoperative treatment. Conservative management may limit soft-tissue complications, while operative treatment may improve alignment and potentially reduce the risk of posttraumatic arthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      The TriNetX Research Network, including 140 million patient records, was used to identify patients with displaced intra-articular calcaneus fractures using\n                      <jats:italic toggle=\"yes\">ICD-10<\/jats:italic>\n                      codes S92.061, S92.062, S92.063 over a 20-year period. Patients were stratified into operative (\n                      <jats:italic toggle=\"yes\">CPT<\/jats:italic>\n                      : 28415, 28420, 28406) and nonoperative (\n                      <jats:italic toggle=\"yes\">CPT<\/jats:italic>\n                      : 28400, 28405) cohorts. Patients with polytrauma or incomplete records were excluded. Propensity score matching adjusted for demographics and comorbidities, yielding 1260 patients per group. Primary outcomes included any adverse event within 90 days and posttraumatic osteoarthritis, nonunion, malunion, and conversion to subtalar fusion at 2 and 5 years. Statistical analyses included\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      test, \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      , and odds ratios with 95% CIs (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Baseline demographics and comorbidities were balanced between groups. At 90 days, operative treatment was associated with significantly higher rates of overall adverse events (8.5% vs 3.6%, OR 2.51,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and lower emergency department utilization (11.5% vs 21.6%, OR 0.47,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). At 5 years, operative patients experienced higher rates of posttraumatic osteoarthritis (6.1% vs 3.8%, OR 1.64,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .008) and implant-related complications (3.6% vs 1.3%, OR 2.71,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Nonunion, malunion, and subtalar fusion rates were similar at all time points.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Operative treatment was associated with higher rates of certain complications. Findings should be interpreted cautiously given limitations, including coding variations, lack of surgical specifics, and inability to stratify by fracture severity. The observed associations do not establish causality, as fracture severity is a critical determinant of outcomes and treatment selection, although the findings are important for informing future studies. Prospective studies incorporating fracture classification, cost-analysis, and patient-reported outcomes are needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level III, retrospective analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24730114261450622","type":"journal-article","created":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T10:10:41Z","timestamp":1780222241000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nonoperative Treatment of Intra-articular Calcaneus Fractures Is Associated With Lower Rates of Certain Long-term Adverse Events Compared to Operative Management: A Retrospective Database Analysis"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8069-4545","authenticated-orcid":false,"given":"Ava M.","family":"McKane","sequence":"first","affiliation":[{"name":"Wake Forest University School of Medicine, Winston-Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8899-6603","authenticated-orcid":false,"given":"N. Reid","family":"Kiritsis","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Winston-Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl V.","family":"Mohr","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Winston-Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9135-0484","authenticated-orcid":false,"given":"Omkar S.","family":"Anaspure","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4456-9445","authenticated-orcid":false,"given":"Conor N.","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5817-3826","authenticated-orcid":false,"given":"Albert T.","family":"Anastasio","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1148\/rg.255045713"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.01475"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cuor.2005.03.005"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2012.0079"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-200302000-00005"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-200105000-00007"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070402501007"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070002101102"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200512000-00019"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-83636-9"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4483"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.01.003"},{"key":"e_1_3_4_14_2","article-title":"Surgical versus non-surgical interventions for displaced intra-articular calcaneal fractures","volume":"11","author":"Lewis SR","year":"2023","unstructured":"Lewis SR, Pritchard MW, Solomon JL, Griffin XL, Bruce J. 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