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Comparison between screw fixation and plate fixation via sinus tarsi approach for displaced intra-articular calcaneal fractures: a systematic review and meta-analysis

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Optimal surgical fixation for displaced intra-articular calcaneal fractures (DIACF) remains a subject of debate, particularly regarding the superiority between screw fixation and plate fixation via the sinus tarsi approach (STA). This review aims to determine the preferred treatment for DIACF and compare the outcomes of minimally invasive surgery options.

Methods

Our study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on distal intra-articular fractures of the calcaneus (DIACFs) that were fixed using cannulated screws or plates via STA. Through a comprehensive meta-analysis, we evaluated several outcomes, including post-operative function, radiological measurements, and complications.

Result

A total of 728 patients from 7 studies met the inclusion criteria. Among them, 435 patients underwent screw fixation via STA, and 373 patients underwent plate fixation via STA. The study found no statistically significant differences between the screw fixation and the plate fixation via sinus tarsi approach (STA) in terms of AOFAS scores, Bohler’s angle, Gissane’s angle, sural nerve injury, secondary subtalar arthrodesis and reoperation. Compared with screw fixation, plate fixation via STA can reduce reduction loss of Bohler’s angle (WMD = − 1.64, 95% CI = [− 2.96, − 0.31], P = 0.06, I2 = 59%), lower the incidence of fixation failure (OR = 0.32, 95% CI = [0.13, 0.81], P = 0.78, I2 = 0%), and decrease intra-articular step-off (WMD = − 0.52, 95% CI = [− 0.87, − 0.17], P = 0.66, I2 = 0%).

Conclusions

Plate fixation demonstrates superior capability in restoring calcaneal width, maintaining Bohler’s angle, and minimizing intra-articular step-off, thereby maintaining better reduction of the subtalar articular surface. In addition, plate fixation exhibits the modest complication rate and a low incidence of fixation failure. Therefore, we recommend the use of plate fixation through the STA, especially for complex and comminuted intra-articular calcaneal fractures.

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Data availability

Data analyzed in this study were a re-analysis of existing data, which are openly available at locations cited in the reference section.

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Acknowledgements

We appreciate all co-authors for their contributions to this study and the writing of this manuscript.

Funding

Supported by Beijing Key Clinical Specialty Project.

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Author notes

  1. Binzhi Zhao, Xiaopei Xu and Qingnan Sun have contributed equally to this work (co-first author).

Authors and Affiliations

  1. Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People’s Republic of China

    Binzhi Zhao, Xiaopei Xu, Qingnan Sun, Yang Liu, Yanrui Zhao, Dong Wang, Yulin Gao & Junlin Zhou

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  1. Binzhi Zhao
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by BZ, XX and QS. The first draft of the manuscript was written by BZ, XX and QS. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Junlin Zhou.

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Ethics approval was not required for this systematic review.

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As this was a systematic review, data from individual participants were not obtained and will not be published.

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Zhao, B., Xu, X., Sun, Q. et al. Comparison between screw fixation and plate fixation via sinus tarsi approach for displaced intra-articular calcaneal fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 144, 59–71 (2024). https://doi.org/10.1007/s00402-023-05041-3

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