Evidence is lacking from these trials concerning the optimal procedure for treatment of displaced intraarticular calcaneal fractures. Clinical trials comparing different treatment , especially as they relate to potential risk fractors such as fracture classification, should be explored.

Taken together,these reports suggestsom e benefitfrom operative com pared with nonoperative treatm entinthe care of displaced calcaneal fractures.In particular,the suggestion that operative care m ay im prove function in certainsubgroups ofpatients who do notreceive workers com pensation m ay be ofparticularclinicalbenefit.Additionalstudies usingpatient-oriented quality oflife m easures to verify the positive results ofsurgery in these subgroups are needed.

Objective To describe dislocation of the elbow with articular fracture of the distal humerus, a type of elbow fracture-dislocation about which little has been written. Methods Four patients with a dislocation of the elbow and fracture of the distal humerus were identified. Three had dislocation and complex intraarticular fracture of the capitellum, trochlea, and lateral epicondyle. Results Two patients (one treated with a second operation to address avascular necrosis of the capitellum) achieved a functional arc of elbow motion and one patient was lost after removal of the implants 3 months after fracture with documented healing. The fourth patient had a complex open fracture dislocation involving the entire articular surface. An attempt to salvage the articular surface resulted in deep infection. Extensive heterotopic bone led to arthrodesis of the elbow. Conclusions Dislocations of the elbow with articular fracture of the humerus are uncommon. Most injuries involve the capitellum, lateral trochlea, and lateral epicondyle. Open reduction and internal fixation of the distal humerus fracture can restore stability without repairing the medial collateral ligament.