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Review
. 2017 Dec;96(49):e9027.
doi: 10.1097/MD.0000000000009027.

Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: A meta-analysis of current evidence base

Ning Wei  1 , Peizhi Yuwen, Wei Liu, Yanbin Zhu, Wenli Chang, Chen Feng, Wei Chen
Affiliations
Review

Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: A meta-analysis of current evidence base

Ning Wei et al. Medicine (Baltimore). 2017 Dec.

Abstract

Background: The relative efficacy of operative and nonoperative treatments for the displaced intra-articular calcaneal fractures (DIACF) remains uncertain.

Object: We conducted a meta-analysis to compare the effectiveness of operative and nonoperative treatments in treating patients with DIACF.

Methods: Databases including Cochrane Library, Medline, Embase, CBM, CNKI, and Google Scholar were searched. After independent study selection by 2 authors, data were extracted and collected independently. Comparisons were performed between operative treatment group and nonoperative treatment group. The quality of included studies was assessed using the Newcastle-Ottawa Scale. RevMan 5.3 was used for data analysis. The primary outcome measures were anatomical measures (changes in Böhler angle and calcaneal height and width), functional measures (shoe problems, resuming preinjury work, and residual pain), and complications (including superficial and deep wound infection, skin flap necrosis, neurovascular injury, secondary arthrodesis, reflex sympathetic dystrophy, osteotomy, thromboembolism, and compartment syndromes).

Results: Eighteen trials (8 randomized controlled trials and 10 controlled clinical trials) including 1467 patients were considered. For anatomical measurements, the overall mean differences (MDs) for the mean Böhler angle, calcaneal height and width were 15.39 (95% confidence interval [CI] 9.12-21.67), 6.55 (95% CI 2.67-10.43), and 7.05 (95% CI -7.83 to -6.27), respectively. In functional measures, the overall effect MD of American Orthopedic Foot and Ankle Society was 6.23 (95% CI 5.22-17.67) and 0.38 (95% CI 0.22-0.67). The overall relative risks (RRs) of wearing shoes, resuming preinjury work, and having residual pain were 0.32 (95% CI 0.32-1.00), 0.56 (95% CI 0.40-0.77), and 0.90 (95% CI 0.68-1.20), respectively. The overall RR of the incidence of complications was 2.00 (95% CI 1.51-2.64).

Conclusion: Operative treatment of DIACF may lead to a higher incidence of complications but has better anatomical recovery when compared with nonoperative treatment.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Recovery of Böhler angle after surgical and nonsurgical treatments.
Figure 3
Figure 3
Changes in calcaneal height after surgical and nonsurgical treatments.
Figure 4
Figure 4
Changes in calcaneal width after surgical and nonsurgical treatments.
Figure 5
Figure 5
Scores on the American Orthopedic Foot and Ankle Society scale after surgical and nonsurgical treatments.
Figure 6
Figure 6
Problems with wearing shoes after surgical and nonsurgical treatments.
Figure 7
Figure 7
Number of patients failing to return to preinjury work after surgical and nonsurgical treatments.
Figure 8
Figure 8
Number of patients who having residual pain after surgical and nonsurgical treatments.
Figure 9
Figure 9
Incidence of complications after surgical and nonsurgical treatments.
See this image and copyright information in PMC

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