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. 2022 May 26;7(2):24730114221101609.
doi: 10.1177/24730114221101609. eCollection 2022 Apr.

Systematic Review of Operative vs Nonoperative Treatment of Displaced Intraarticular Calcaneal Fractures

Amr Selim  1   2 , Nikhil Ponugoti  3 , Suresh Chandrashekar  2
Affiliations

Systematic Review of Operative vs Nonoperative Treatment of Displaced Intraarticular Calcaneal Fractures

Amr Selim et al. Foot Ankle Orthop. .

Abstract

Background: Management of displaced intraarticular calcaneus fractures can be operative or nonoperative. Several randomized and case-controlled trials have been recently conducted in order to reach a consensus. The purpose of this analysis is to provide recommendations for the management of these injuries based on the best available clinical evidence.

Methods: An up-to-date search was conducted using predefined eligibility criteria. The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) was followed. Randomized and prospective clinical trials were only included after agreement among all authors. Relevant literature was appraised for methodologic quality using the Cochrane collaboration tool for the randomized controlled trials (RCTs) and Newcastle Ottawa Score for the prospective trials. Outcome measures included American Orthopaedic Foot & Ankle Society ankle-hindfoot score, visual analog scale score, return to activity, complications, residual pain, and development of arthritis. RevMan, version 5.3.5 software, was used for data analysis. A P value of <.05 was considered statistically significant, and CIs were set at 95%.

Results: A total of 13 studies and 1251 patients were included in our analysis. This involved 10 RCTs and 3 prospective clinical trials. Shoe fitting problems and failure to return to activity favored the operative group. No other studied variables showed clear superiority of a specific treatment approach.

Conclusion: The best evidence available at this time favors an advantage to operative treatment. Patients should be informed that the clear differences are centered on comfort of shoe wear and return to desired activity level.Level of Evidence: Level II, meta-analysis of RCT and Prospective Cohort studies.

Keywords: calcaneus; conservative; displaced; intraarticular fractures; operative.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
PRISMA flowchart for the meta-analysis.
Figure 2.
Figure 2.
A figure displaying the risk of bias for the randomized controlled trials included in the meta-analysis. Each color represents the risk of bias in each of the domains (red = high risk, yellow = unclear, and green = low risk).
Figure 3.
Figure 3.
A figure displaying the risk of bias for each of the included randomized controlled trials. The color represents the quality in the each of the domains (red = high risk, yellow = uncertain, and green = low risk).
Figure 4.
Figure 4.
Forest plots showing the comparison of (A) shoe fitting problems and (B) failure to return to activity between the 2 groups. (IV, independent variable; M-H, Mantel-Haenszel.)
Figure 5.
Figure 5.
Forest plots showing the comparison of (A) AOFAS score and (B) residual pain between the 2 groups. (AOFAS, American Orthopaedic Foot & Ankle Society ankle-hindfoot score; IV, independent variable; M-H, Mantel-Haenszel.)
Figure 6.
Figure 6.
Forest plots showing the comparison of (A) complications and (B) development of arthritis between the 2 groups. (IV, independent variable; M-H, Mantel-Haenszel.)
See this image and copyright information in PMC

References

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