ReviewOperative Versus Nonoperative Treatment for Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials
Section snippets
Criteria for Considering Studies for Our Meta-Analysis
All RCTs comparing operative and nonoperative treatment for DIACF were eligible. The participants were limited to adult patients with fresh, closed displaced intra-articular calcaneal fractures. Patients undergoing open reduction with any type of internal fixation method were considered for the present study. To avoid repeated calculations, multiple reports of the same patient population were pooled as 1 study.
Search Methods for Identification of Studies
Two reviewers (She. H., Q.L.) independently searched the Cochrane Central Register of
Description of Studies
The process of study selection is displayed in the flowchart (Fig. 1). A total of 7 studies (8 reports) were included in the present meta-analysis 17, 18, 19, 20, 21, 22, 23, 24. Parmar et al (18) and Ibrahim et al (17) reported the results of the same patients with different follow-up periods. A total of 824 patients were included in the 7 studies: 404 patients in the operative group and 420 in the nonoperative group. The 7 included studies were published between 1993 and 2014, all in English.
Discussion
The controversy over operative treatment for a DIACF remains a topic in published studies because of the greater incidence of postoperative complications, which was reported to be 16% to 28% 9, 12, 25. From the results of the present meta-analysis, we have found that no significant differences exist in the functional results between operative and nonoperative treatment for DIACF. Although operative treatment might reduce the risk of late subtalar arthrodesis, it is associated with a greater
References (35)
- et al.
Management of displaced intra-articular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weight bearing
J Foot Ankle Surg
(2004) - et al.
The hindfoot: calcaneal and talar fractures and dislocations—part I: fractures of the calcaneum
Curr Orthop
(2005) Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in elderly patients
J Foot Ankle Surg
(2010)- et al.
Long-term outcomes of 1,730 calcaneal fractures: systematic review of the literature
J Foot Ankle Surg
(2013) - et al.
Displaced intra-articular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment
Injury
(2007) - et al.
Sanders type II calcaneum fractures—surgical or conservative treatment? A prospective randomized trial
J Clin Orthop Trauma
(2011) - et al.
Wound complications following operative fixation of calcaneal fractures
Injury
(2000) - et al.
Displaced intra-articular calcaneal fractures
J Orthop Trauma
(2005) - et al.
Intraarticular fractures of calcaneus-current concepts of treatment
Pol Orthop Traumatol
(2014) - et al.
Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment
J Foot Ankle Surg
(2014)
Results of operative treatment for intra-articular fractures of the calcaneus
J Trauma
Long-term results of calcaneal fracture treatment by open reduction and internal fixation using a calcaneal locking compression plate from an extended lateral approach
Acta Chir Orthop Traumatol Cech
Management of calcaneal fractures: systematic review of randomized trials
Br Med Bull
Surgical versus conservative interventions for displaced intra-articular calcaneal fractures
Cochrane Database Syst Rev
Should calcaneal fractures be treated surgically? A meta-analysis
Clin Orthop Relat Res
Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base
Int Orthop
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Financial Disclosure: None reported.
Conflict of Interest: None reported.