SLR - July 2012 - Stephen Dini
Reference: Jiang N, Lin QR, Diao XC, Wu L, Yu B. Int Orthop. 2012 May 11
Scientific Literature Review
Reviewed by: Stephen Dini, DPM
Residency Program: New York Hospital of Queens
Podiatric Relevance:
Calcaneal fractures are the most frequent injury of the tarsal bones, representing two percent of all fractures in the body. The debate surrounding surgical versus non-surgical management of displaced intra-articular calcaneal fractures has been inconclusive due to the varied results of previous randomized control trials (RCT) with limited study sizes. The aim of this meta-analysis was to determine the advantages and disadvantages of surgical versus nonsurgical displaced intra-articular calcaneal fractures (DIACF) in all related available randomized clinical trials (RCTs) and clinical controlled trials (CCT).
Methods:
The study searched four electronic databases for RCTs and CCTs for comparison studies of surgical and nonsurgical treatments of DIACF from 1980 to 2011. The studies were reviewed and analyzed utilizing the modified Jadad scale to determine the quality of each study. The outcomes of the studies were classified as anatomical restoration, functional recovery, incidence of complications and anatomical measurements including Bohler’s angle, calcaneal height and calcaneal width.
Results:
Six RCTs and four CCTs with a total of 891 patients were utilized for the meta-analysis meeting all the inclusion criteria. The results showed significantly smaller mean Bohler’s angle in nonsurgical patients compared to surgically treated patients, a significant loss of calcaneal height in the nonsurgical group, and a significantly more stable calcaneal width in the surgically treated patients. The surgically treated patients had fewer issues returning to pre-injury work and fitting into regular shoes. There was no significant difference in regard to residual pain between the groups in the follow-up period. There was a significantly higher complication rate in the surgical group compared to nonsurgical treatment (22.8 percent vs.16.2 percent; p=0.008).
Conclusions:
Surgical treatment may increase the complication rate of infection or skin necrosis, but leads to better reconstruction of the calcaneus for optimal functional results. A percutaneous approach has reduced the complications of DIACF surgical management indicating promising results in the future with improved techniques. Overall, the authors concluded that surgical management remains the optimal choice in DIACF treatment.