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Review
. 2012 Aug;36(8):1615-22.
doi: 10.1007/s00264-012-1563-0. Epub 2012 May 11.

Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

Nan Jiang  1 , Qing-rong Lin, Xi-cai Diao, Liang Wu, Bin Yu
Affiliations
Review

Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

Nan Jiang et al. Int Orthop. 2012 Aug.

Abstract

Purpose: Controversy still surrounds the optimal treatment for patients with displaced intra-articular calcaneal fractures (DIACF). An up-to-date meta-analysis was performed to evaluate clinical effectiveness of surgical treatment for DIACF compared with nonsurgical treatment.

Methods: We systematically searched four electronic databases (Medline, BIOSIS, Cochrane library and Google Scholar) to identify randomised controlled trials (RCTs) and clinical controlled trials (CCTs) in which surgical treatment was compared with nonsurgical treatment of DIACF from 1980 to 2011. Trial quality was assessed using the modified Jadad scale and effective data were pooled for meta-analysis.

Results: Ten studies (six RCTs and four CCTs) with a total of 891 participants were screened. Results showed that surgical treatment was superior to nonsurgical treatment in better recovery of the Böhler angle (P < 0.0001), more stable calcaneal height (P = 0.0009) and width (P < 0.00001). Moreover, fewer surgically treated patients needed increased shoe size (P = 0.0004) and more were able to resume pre-injury work (P = 0.004) than the nonsurgical patients. No significant difference was identified between the two methods regarding the incidence of residual pain (P = 0.49). However, operative management was associated with a higher risk of complications (P = 0.008).

Conclusions: Although surgical repair may increase the complication probability, it is the price that has to be paid for better reconstruction of the calcaneus and better functional results. Taken as a whole, surgery is probably the optimal choice in DIACF treatment.

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Figures

Fig. 1
Fig. 1
Flow chart of eligibility selection
Fig. 2
Fig. 2
Recovery of Böhler angle after surgical and nonsurgical treatments
Fig. 3
Fig. 3
Changes in calcaneal height after surgical and nonsurgical treatments
Fig. 4
Fig. 4
Changes in calcaneal width after surgical and nonsurgical treatments
Fig. 5
Fig. 5
The number of patients who had problems in wearing shoes after surgical and nonsurgical treatments
Fig. 6
Fig. 6
The number of patients who failed to resume pre-injury work after surgical and nonsurgical treatments
Fig. 7
Fig. 7
The number of patients who had residual pain after surgical and nonsurgical treatments
Fig. 8
Fig. 8
Incidence of complications after surgical and nonsurgical treatments
See this image and copyright information in PMC

References

    1. Zwipp H, Rammelt S, Barthel S. Calcaneal fractures—the most frequent tarsal fractures. Ther Umsch. 2004;61:435–450. doi: 10.1024/0040-5930.61.7.435. - DOI - PubMed
    1. McBride D, Ramamurthy C, Laing P (2005) The hindfoot: calcaneal and talar fractures and dislocations, part I. Fractures of the calcaneum. Curr Orthop 94–100
    1. Bajammal S, Tornetta PR, Sanders D, Bhandari M. Displaced intra-articular calcaneal fractures. J Orthop Trauma. 2005;19:360–364. - PubMed
    1. Stulik J, Stehlik J, Rysavy M, Wozniak A. Minimally-invasive treatment of intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2006;88:1634–1641. doi: 10.1302/0301-620X.88B12.17379. - DOI - PubMed
    1. Thordarson DB, Krieger LE. Operative vs. nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int. 1996;17:2–9. - PubMed