Background
Review
Introduction
Materials and methods
Health-related quality of life (HRQoL)
Search strategy
PubMed: |
(calcaneus[tiab] OR calcaneum[tiab] OR calcaneal[tiab] OR calcis[tiab] OR kalkaneus[tiab] OR (heel[tiab] AND bone[tiab]) OR fersenbein[tiab] OR hielbeen[tiab] OR hielbot[tiab] OR calcanean[tiab] OR calcanea[tiab]) AND (fracture[tiab] OR fractures[tiab] OR lesion[tiab] OR lesions[tiab] OR broken[tiab] OR fractured[tiab] OR splintered[tiab] OR displaced[tiab] OR displacement[tiab] OR discontinuity[tiab] OR discontinuities[tiab] OR gebroken[tiab] OR fracture[tiab] OR frakturen[tiab] OR fractuur[tiab] OR fracturen[tiab] OR fragmentation[tiab] OR fragmented[tiab] OR fragment[tiab] OR cleavage[tiab] OR cleavages[tiab]) AND (sf36[tiab] OR sf-36[tiab] OR (sf[tiab] AND 36[tiab]) OR (health[tiab] AND (survey[tiab] OR surveys[tiab] OR review[tiab] OR reviews[tiab] OR questionnaire[tiab] OR questionnaires[tiab])) OR (short[tiab] AND (form[tiab] OR form-36[tiab])) OR short-form[tiab] OR euroqol[tiab] OR euroqol-5[tiab] OR euroqol-6[tiab] OR eq-5d[tiab] OR eq-6d[tiab] OR (quality[tiab] AND life[tiab]) OR ((clinical[tiab] OR functional[tiab]) AND (assessment[tiab] OR score[tiab] OR scores[tiab] OR outcome[tiab] OR outcomes[tiab]))) |
Embase: |
calcaneus:ab,ti OR calcaneum:ab,ti OR calcaneal:ab,ti OR calcis:ab,ti OR kalkaneus:ab,ti OR (heel:ab,ti AND bone:ab,ti) OR fersenbein:ab,ti OR hielbeen:ab,ti OR hielbot:ab,ti OR calcanean:ab,ti OR calcanea:ab,ti AND (fractures:ab,ti OR lesion:ab,ti OR lesions:ab,ti OR broken:ab,ti OR fractured:ab,ti OR splintered:ab,ti OR displaced:ab,ti OR displacement:ab,ti OR discontinuity:ab,ti OR discontinuities:ab,ti OR gebroken:ab,ti OR fracture:ab,ti OR frakturen:ab,ti OR fractuur:ab,ti OR fracturen:ab,ti OR fragmentation:ab,ti OR fragmented:ab,ti OR fragment:ab,ti OR cleavage:ab,ti OR cleavages:ab,ti) AND (sf36:ab,ti OR ‘sf 36’:ab,ti OR (sf:ab,ti AND 36:ab,ti) OR (health:ab,ti AND (survey:ab,ti OR surveys:ab,ti OR review:ab,ti OR reviews:ab,ti OR questionnaire:ab,ti OR questionnaires:ab,ti)) OR (short:ab,ti AND (form:ab,ti OR ‘form 36’:ab,ti)) OR ‘short form’:ab,ti OR euroqol:ab,ti OR ‘euroqol 5’:ab,ti OR ‘euroqol 6’:ab,ti OR ‘eq 5d’:ab,ti OR ‘eq 6d’:ab,ti OR (quality:ab,ti AND life:ab,ti) OR (clinical:ab,ti OR functional:ab,ti AND (assessment:ab,ti OR score:ab,ti OR scores:ab,ti OR outcome:ab,ti OR outcomes:ab,ti))) |
Cochrane Library: searched in title, abstract and keywords |
(calcaneus OR calcaneum OR calcaneal OR calcis OR kalkaneus OR (heel AND bone) OR fersenbein OR hielbeen OR hielbot OR calcanean OR calcanea) AND (fracture OR fractures OR lesion OR lesions OR broken OR fractured OR splintered OR displaced OR displacement OR discontinuity OR discontinuities OR gebroken OR fracture OR frakturen OR fractuur OR fracturen OR fragmentation OR fragmented OR fragment OR cleavage OR cleavages) AND (sf36 OR sf-36 OR (sf AND 36) OR (health AND (survey OR surveys OR review OR reviews OR questionnaire OR questionnaires)) OR (short AND (form OR form-36)) OR short-form OR euroqol OR euroqol-5 OR euroqol-6 OR eq-5d OR eq-6d OR (quality AND life) OR ((clinical OR functional) AND (assessment OR score OR scores OR outcome OR outcomes))) |
Selection
Critical appraisal
Study design | + | Prospective study or randomized controlled trial | |
± | Retrospective study | ||
- | Other, such as case report | ||
Relevance
| |||
Domain | + | Studies including adult trauma patients with DIACF | |
± | Studies including adult trauma patients with other calcaneal fractures | ||
- | Studies including adult trauma patients with other solitary non-calcaneal fractures | ||
Outcome | + | SF-36, SF-26v2, EQ-5D or EQ-6D | |
- | Other | ||
Validity
| Points | ||
Transparency of methodology | + | Clearly described methodology | - |
- | Not clearly described methodology or not reported | - | |
Characteristics of study population (age, classification of calcaneal fracture, length of follow-up, and associated injuries) | + | Clearly described study population characteristics and inclusion of all characteristics | - |
- | Not clearly described study population characteristics or missing description of characteristics | - | |
Minimal selection bias | + | All eligible patients included in the study population | +5 |
± | Pre-selected patient groups or subgroups | +3 | |
- | Subjective selection of eligible patients or not reported | −3 | |
Outcome assessment | + | Complete mean crude scores per subdomain in patient group, or crude scores per subdomain | +6 |
± | Incomplete mean crude scores per subdomain, or mean cumulative scores or EQ-5D index scores | +4 | |
- | No subdivision of the mean total scores in the subdomains or cumulative scores | 0 | |
Lost to follow-up | + | <15 % | +4 |
± | 15 to 25 % | +2 | |
- | >25 % or not reported | 0 | |
Missing data | + | Description of patient characteristics who are lost to follow-up and how the missing data was handled | +1 |
- | No description of patient characteristics who are lost to follow-up or how missing data was handled | 0 | |
Standardization of the conduction of the questionnaires | + | Standardized | +2 |
- | Not standardized or not reported | 0 | |
Total points | |||
Overall risk of bias | + | Low risk of bias | 14 to 18 |
± | Medium risk of bias | 10 to 13 | |
- | High risk of bias | −3 to 9 |
Data extraction
Results
Search strategy & selection
Critical appraisal
Relevance
|
Validity
| ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Study design | Domain | Outcome | Transparency of methodology | Characteristics of population | Minimal selection bias | Outcome assessment | Lost to follow-up | Missing data | Standardization of conduction | Risk of Bias | |
Hildebrand (1996) [32] | RCS | + | + | + | - | - | - | + | NA | - | - |
Heffernan (2000) [33] | RCS | + | + | - | - | + | ± | + | - | - | ± |
Kennedy (2003) [34] | RCS | + | + | - | - | - | - | + | NA | - | - |
Berry (2004) [35] | RCS | + | + | + | + | ± | ± | - | - | + | - |
Van Tetering (2004) [7] | RCT | + | + | + | - | ± | + | ± | - | + | ± |
Westphal (2004) [8] | RCS | + | + | + | + | ± | + | + | - | - | ± |
Herscovici (2005) [36] | RCS | ± | + | + | + | ± | - | ± | - | + | - |
Allmacher (2006) [27] | RCS | + | + | + | - | ± | ± | - | - | - | - |
Robb (2007) [37] | RCS | + | + | + | - | - | + | ± | - | + | - |
Johal (2009) [38] | RCT | + | + | + | - | + | + | ± | - | - | ± |
Rubino (2009) [28] | RCS | + | + | + | - | ± | - | - | - | + | - |
Wee (2009) [39] | PCS | + | + | + | + | ± | - | - | + | - | - |
DeWall (2010) [40] | RCS | + | + | + | - | + | ± | - | - | - | - |
Kinner (2010) [41] | PCSS | + | + | + | + | ± | + | NR | - | + | ± |
Makki (2010) [6] | RCS | + | + | + | + | ± | ± | + | - | + | ± |
Hirschmüller (2011) [42] | RCS | ± | + | + | + | - | + | + | - | - | - |
Tomesen (2011) [43] | RCS | + | + | + | + | ± | - | ± | - | + | - |
Woon (2011) [44] | PCS | + | + | + | - | ± | - | NR | - | - | - |
Beltran (2012) [45] | RCS | + | + | + | - | ± | ± | + | - | - | ± |
Brunner (2012) [46] | RCS | + | + | + | - | ± | + | ± | - | + | ± |
Ågren (2013) [47] | RCT | + | + | + | - | ± | ± | - | - | + | - |
De Groot (2013) [48] | RCS | + | + | + | - | ± | + | - | - | + | ± |
Demiralp (2013) [49] | RCS | ± | + | + | - | - | - | NR | - | + | - |
Kline (2013) [50] | RCS | + | + | + | - | ± | - | - | - | + | - |
Rammelt (2013) [51] | RCS | + | + | + | - | + | ± | - | - | - | - |
Tornetta (2013)[52] | PCS | ± | + | + | - | - | ± | NR | - | - | - |
Buckley (2014) [53] | RCT | + | + | + | ± | ± | ± | ± | - | + | ± |
Chen (2014) [54] | RCS | + | + | + | ± | ± | - | NR | - | + | - |
De Boer (2014) [55] | RCS | + | + | + | + | ± | ± | - | + | + | ± |
Griffin (2014) [56] | RCT | + | + | + | + | ± | ± | ± | + | + | ± |
Persson (2014) [57] | RCS | ± | + | + | + | ± | ± | - | - | + | - |
Sanders (2014) [58] | PCS | + | + | + | + | ± | ± | - | + | + | ± |
Data extraction
Questionnaire | Number of patients (n=) | Reported classification of calcaneal fracture type | Mean age in years (range) | Other characteristics of studied population | Treatment | Mean follow-up time in months (range) | SF-36 mean scores | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Physical functioning | Role-physical | Bodily pain | General health | Vitality | Social functioning | Role-emotional | Mental health | Physical component summary | Mental component summary | ||||||||
Johal (2009) [38] | SF-36 | 41 | Sanders | 36 (18–61) | Exclusion of open fractures, aged >65 years, medical contraindications or intoxication abuses | ORIF | >12 (NR) | 59 | 40 | 51 | 77 | 63 | 67 | 65 | 74 | - | - |
Van Tetering (2004) [7] | SF-36 | 312 | NR | NR (25–64) | Exclusion of open fractures and age <25 and >65 years. Possible exclusion of patients who received secondary subtalar arthrodesis | ORIF or non-operative | 23 (12–24) | 67 (SD 27) | 54 (SD 43) | 57 (SD 26) | 69 (SD 20) | 60 (SD 21) | 73 (SD 27) | 72 (SD 38) | 72 (SD 19) | - | - |
Griffin (2014) [56] | SF-36 | 116 | Sanders | 47 (18–80) | Exclusion of open fractures, gross deformity, other serious leg injury or peripheral vascular disease | Operative (n = 62), non-operative (n = 54) | 24 (NR) | - | - | - | - | - | - | - | - | 40c (SD 13) | 54c (SD 12) |
Buckley (2014) [53] | SF-36 version 2 | 24 | Sanders | 40 (SD 13) | Closed Sanders type IV fractures; exclusion age <16 and >59 years, inability of diminishing smoking after injury | ORIF (n = 11), ORIF and primary arthrodesis (n = 13) | ≥24 (24–84) | - | - | - | - | - | - | - | - | 34c (SD 11) | - |
Heffernan (2000) [33] | SF-36 | 25 | NR | 44 (22–65) at time of injury | - | ORIF | 30 (12–48) | Median83 (range 70–100) | - | Median84 (range 27–100) | - | - | - | - | - | - | - |
Westphal (2004) [8] | SF-36 | 71 | Sanders | 42 (22–73) at time of injury | Exclusion of bilateral or open fractures, or having other injuries | ORIF, secondary arthrodesis (n = 4) | 32 (11–90) | 61 (SD 25) | 52 (SD 43) | 49 (SD 27) | 58 (SD 20) | 56 (SD 20) | 79 (SD 23) | 74 (SD 40) | 69 (SD 21) | - | - |
Brunner (2012) [46] | SF-36 | 54 | OTA | NR | Exclusion of other fixation systems | ORIF | 42 (24–82) | 62 | 68 | 53 | 43 | 49 | 83 | 90 | 41 | - | - |
Kinner (2010) [41] | SF-36 | 44 | Sanders | 46 (18–65) | Complete clinical and radiographic documentation. Exclusion aged <65. | ORIF (n = 32), percutaneous (n = 12) | 42 (12–60) | 66 | 66 | 58 | 64 | 60 | 81 | 79 | 76 | - | - |
Beltran (2012) [45] | SF-36 | 15 | Sanders | 43 (16–67) | High-grade open calcaneal fractures only | Percutaneous | 49 (13–106) | 40 (SD 13) | 43 (SD 16) | 48 (SD 10) | 52 (SD 8) | 48 (SD 10) | 44 (SD 10) | - | - | 44c (SD 12) | 49c (SD 13) |
De Boer (2014) [55] | SF-36 | 78 | Sanders/ Essex-Lopresti | 46 (30–55) at time of injury | Exclusion of age >70, primary arthrodesis or amputation, Gustilo grade III, intoxication abuses or wheelchair-bound. | ORIF (n = 27), non-operative (n = 18), percutaneous (n = 33) | 76 (54–88) | - | - | - | - | - | - | - | - | Median 48a
| Median 57a
|
De Groot (2013) [48] | SF-36 | 41 | NR | 46 (SD 11) (21–66) | Exclusion of open fractures, severe mental illness or do not reside nearby | ORIF (n = 39), unknown (n = 2) | 78 (24–192) | 74 (SD 21) | 65 (SD 41) | 71 (SD 22) | 70 (SD 19) | 70 (SD 20) | 85 (SD 22) | 81 (SD 35) | 79 (SD 20) | - | - |
Makki (2010) [6] | SF-36 version 2 | 41 | Sanders | 56 (27–85) at time of follow-up | Exclusion of comminution of sustentacular fragment; open fractures; exclusion of secondary arthrodesis | ORIF | 120 (84–180) | - | - | - | - | - | - | - | - | 50bc (SD 7) | 54bc (SD 4) |
Sanders (2014) [58] | SF-36 version 2 | 66 | Sanders/Essex-Lopresti | 60 (SD 15) (29–91) at time of follow-up | Exclusion of open fractures, concomitant injuries, incomplete radiographic documentation, Sanders type IV, unsuited for operative treatment or subtalar fusion | ORIF | 181 (126–256) | - | - | - | - | - | - | - | - | 46c (SD 9) | 55c (SD 11) |
Discussion
Conclusions
-
This systematic review reveals that the identified studies have a medium to high risk of bias that might cause underestimation of the HRQoL after a DIACF; hence, it is challenging to make reliable and valid conclusions.
-
This systematic review indicates that DIACF is a life-changing event for most patients.