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Calcaneal Fractures Management, Change of Clinical Practice in Recent Years from ELA to STA: A Systematic Review and Meta-Analysis

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Abstract

Background

Calcaneal fractures are serious injuries that mainly affect young, active people. As a result, these fractures may cause long-term impairment and have a major socioeconomic impact. The current updated systematic review and meta-analysis were conducted to evaluate the functional outcomes, re-operative risk, and complications associated with the treatment of displaced intra-articular calcaneal.

Methodology

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this meta-analysis. The literature search was carried out using PubMed, Cochrane, MEDLINE, Google Scholar, and the EMBASE databases with the appropriate keywords.

Results

A total of 13 studies were included in this review. The follow-up months were diverse, ranging between 12 and 65 months in sinus tarsi approach (STA) and 12 to 76 months in extended lateral approach (ELA) methods. Time to surgery was shorter for the STA when compared to ELA (MD: 3.48; 95% CI 2.43 to 4.53; p < 0.00001). No significant difference was observed in functional outcomes between STA and ELA (MD: 0.34; 95% CI: −0.37 to 1.04; p = 0.35 > 0.05; I2 = 88%). In comparison to the ELA, the STA has significantly less wound healing complications (RR: 0.20; 95% CI 0.11 to 0.36; p 0.00001; I2 = 0%).

Conclusion

In conclusion, the STA technique in treating calcaneal fractures was significantly safer and more effective when compared to the ELA methods. The STA method of treatment was found to have a lower risk of complications and an infection rate, as well as a shorter operating and recovery time.

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References

  1. Gougoulias, N., McBride, D., & Maffulli, N. (2021). Outcomes of management of displaced intra-articular calcaneal fractures. The Surgeon, 19(5), e222–e229. https://doi.org/10.1016/j.surge.2020.10.003

    Article  PubMed  Google Scholar 

  2. Gupta, D. K., Garg, A., & Jindal, M. (2020). Role of percutaneous fixation of displaced intra articular calcaneal fractures with cancellous cannulated screws. IAR Journal of Medical Sciences, 1(1), 36–39.

    Google Scholar 

  3. Mitchell, M. J., McKinley, J. C., & Robinson, C. M. (2009). The epidemiology of calcaneal fractures. The Foot, 19(4), 197–200. https://doi.org/10.1016/j.foot.2009.05.001

    Article  CAS  PubMed  Google Scholar 

  4. Lim, E. V. A., & Leung, J. P. F. (2001). Complications of intraarticular calcaneal fractures. Clinical Orthopaedics and Related Research®, 391, 7–16.

    Article  Google Scholar 

  5. Malik, C., Najefi, A. A., Patel, A., et al. (2022). Percutaneous subtalar joint screw fixation of comminuted calcaneal fractures: A salvage procedure. European Journal of Trauma and Emergency Surgery. https://doi.org/10.1007/s00068-022-01923-0

    Article  PubMed  Google Scholar 

  6. Bušková, K., Bartoníček, J., & Rammelt, S. (2021). Fractures of the base of the fifth metatarsal bone. JBJS Reviews. https://doi.org/10.2106/JBJS.RVW.21.00010

    Article  PubMed  Google Scholar 

  7. Nosewicz, T. L., Dingemans, S. A., Backes, M., Luitse, J. S. K., Goslings, J. C., & Schepers, T. (2019). A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures. Foot and Ankle Surgery, 25(5), 580–588. https://doi.org/10.1016/j.fas.2018.08.006

    Article  PubMed  Google Scholar 

  8. Ozturk, A. M., Ozer, M. A., Suer, O., Derin, O., Govsa, F., & Aktuglu, K. (2022). Evaluation of the effects of using 3D - patient specific models of displaced intra - articular calcaneal fractures in surgery. Injury. https://doi.org/10.1016/j.injury.2020.04.057

    Article  PubMed  Google Scholar 

  9. Nosewicz, T., Knupp, M., Barg, A., et al. (2012). Mini-open sinus tarsi approach with percutaneous screw fixation of displaced calcaneal fractures: A prospective computed tomography–based study. Foot & Ankle International, 33(11), 925–933. https://doi.org/10.3113/FAI.2012.0925

    Article  Google Scholar 

  10. Zhang, W., Lin, F., Chen, E., Xue, D., & Pan, Z. (2016). Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures. Journal of Orthopaedic Trauma, 30(3), e75–e81. https://doi.org/10.1097/BOT.0000000000000446

    Article  PubMed  Google Scholar 

  11. Ågren, P. H., Wretenberg, P., & Sayed-Noor, A. S. (2013). Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures. The Journal of Bone & Joint Surgery, 95(15), 1351–1357. https://doi.org/10.2106/JBJS.L.00759

    Article  Google Scholar 

  12. Pastor, T., Gradl, G., Klos, K., et al. (2016). Displaced intra-articular calcaneal fractures: Is there a consensus on treatment in Germany? International Orthopaedics, 40(10), 2181–2190. https://doi.org/10.1007/s00264-016-3134-2

    Article  PubMed  Google Scholar 

  13. Zhang Y, Weng Q, Chen J, Yang Y (2021) The spatial weaving screw technique combined with minimally invasive treatment of calcaneal fracture. https://www.researchsquare.com/article/rs-244666/latest.pdf.

  14. Benirschke, S. K., & Kramer, P. A. (2004). Wound healing complications in closed and open calcaneal fractures. Journal of Orthopaedic Trauma, 18(1), 1–6.

    Article  PubMed  Google Scholar 

  15. Meena, S., Gangary, S. K., & Sharma, P. (2016). Review article: Operative versus non-operative treatment for displaced intra-articular calcaneal fracture: A meta-analysis of randomised controlled trials. Journal of Orthopaedic Surgery, 24(3), 411–416. https://doi.org/10.1177/1602400328

    Article  PubMed  Google Scholar 

  16. Liberati, A., Altman, D., Tetzlaff, J., et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), 100. https://doi.org/10.1371/journal.pmed.1000100

    Article  Google Scholar 

  17. Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., et al. (2011). The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343, d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  18. Slim, K., Nini, E., Forestier, D., Kwiatkowski, F., Panis, Y., & Chipponi, J. (2003). Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument. ANZ Journal of Surgery, 73(9), 712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  19. Li, L.-h, Guo, Y.-z, Wang, H., et al. (2016). Less wound complications of a sinus tarsi approach compared to an extended lateral approach for the treatment of displaced intraarticular calcaneal fracture. Medicine (Baltimore), 95(36), e4628. https://doi.org/10.1097/MD.0000000000004628

    Article  PubMed  Google Scholar 

  20. Yeo, J. H., Cho, H. J., & Lee, K. B. (2015). Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: Sinus tarsi versus extensile lateral approach. BMC Musculoskeletal Disorders, 16(1), 63. https://doi.org/10.1186/s12891-015-0519-0

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wang, J., Qin, S., Wang, T., Liu, J., & Wang, Z. (2021). Comparison of the curative effect of percutaneous reduction with plastic calcaneal forceps combined with medial external fixation in the treatment of intra-articular calcaneal fractures. Orthopaedic Surgery, 13(8), 2344–2354. https://doi.org/10.1111/os.13118

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schepers, T., Backes, M., Dingemans, S. A., de Jong, V. M., & Luitse, J. S. K. (2017). Similar anatomical reduction and lower complication rates with the sinus tarsi approach compared with the extended lateral approach in displaced intra-articular calcaneal fractures. Journal of Orthopaedic Trauma, 31(6), 293–298. https://doi.org/10.1097/BOT.0000000000000819

    Article  PubMed  Google Scholar 

  23. Kline, A. J., Anderson, R. B., Davis, W. H., Jones, C. P., & Cohen, B. E. (2013). Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot & Ankle International, 34(6), 773–780. https://doi.org/10.1177/1071100713477607

    Article  Google Scholar 

  24. Zhou, H.-c, Yu, T., Ren, H.-y, et al. (2017). Clinical comparison of extensile lateral approach and sinus tarsi approach combined with medial distraction technique for intra-articular calcaneal fractures. Orthopaedic Surgery, 9(1), 77–85. https://doi.org/10.1111/os.12310

    Article  PubMed  PubMed Central  Google Scholar 

  25. Basile, A., Albo, F., & Via, A. G. (2016). Comparison between sinus tarsi approach and extensile lateral approach for treatment of closed displaced intra-articular calcaneal fractures: A multicenter prospective study. Journal of Foot and Ankle Surgery, 55(3), 513–521. https://doi.org/10.1053/j.jfas.2015.11.008

    Article  Google Scholar 

  26. Weber, M., Lehmann, O., Sägesser, D., & Krause, F. (2008). Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. The Journal of Bone & Joint Surgery British, 90-B(12), 1608–1616. https://doi.org/10.1302/0301-620X.90B12.20638

    Article  Google Scholar 

  27. Xia, S., Lu, Y., Wang, H., Wu, Z., & Wang, Z. (2014). Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures – a randomized controlled trial. International Journal of Surgery, 12(5), 475–480. https://doi.org/10.1016/j.ijsu.2014.03.001

    Article  PubMed  Google Scholar 

  28. Howard, J. L., Buckley, R., McCormack, R., et al. (2003). Complications following management of displaced intra-articular calcaneal fractures: A prospective randomized trial comparing open reduction internal fixation with nonoperative management. Journal of Orthopaedic Trauma, 17(4), 241–249. https://doi.org/10.1097/00005131-200304000-00001

    Article  CAS  PubMed  Google Scholar 

  29. Jiang, N., Lin, Q.-r, Diao, X.-c, Wu, L., & Yu, B. (2012). Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. International Orthopaedics, 36(8), 1615–1622. https://doi.org/10.1007/s00264-012-1563-0

    Article  PubMed  PubMed Central  Google Scholar 

  30. Thakore, R. V., Greenberg, S. E., Shi, H., et al. (2015). Surgical site infection in orthopedic trauma: A case–control study evaluating risk factors and cost. Journal of Clinical Orthopaedics and Trauma, 6(4), 220–226. https://doi.org/10.1016/j.jcot.2015.04.004

    Article  PubMed  PubMed Central  Google Scholar 

  31. Clement, R. C., Lang, P. J., Pettett, B. J., Overman, R. A., Ostrum, R. F., & Tennant, J. N. (2017). Sanders II/III calcaneus fractures in laborers: A cost-effectiveness analysis and call for effectiveness research. Journal of Orthopaedic Trauma, 31(6), 299–304. https://doi.org/10.1097/BOT.0000000000000813

    Article  PubMed  Google Scholar 

  32. Borrelli, J., & Lashgari, C. (1999). Vascularity of the lateral calcaneal flap: A cadaveric injection study. Journal of Orthopaedic Trauma, 13(2), 73–77. https://doi.org/10.1097/00005131-199902000-00001

    Article  PubMed  Google Scholar 

  33. Takasaka, M., Bittar, C. K., Mennucci, F. S., de Mattos, C. A., & Zabeu, J. L. A. (2016). Comparative study on three surgical techniques for intra-articular calcaneal fractures: Open reduction with internal fixation using a plate, external fixation and minimally invasive surgery. Revista Brasileira de Ortopedia, 51(3), 254–260. https://doi.org/10.1016/j.rboe.2016.04.002

    Article  PubMed  PubMed Central  Google Scholar 

  34. Chen, J., Yang, Z., Kong, C., & Wei, S. (2020). Minimally invasive dual incision with mini plate internal fixation improves outcomes over 30 months in 20 patients with Sanders type III calcaneal fractures. Journal of Orthopaedic Surgery and Research, 15(1), 167. https://doi.org/10.1186/s13018-020-01644-3

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gao, X., Fan, H., Huang, R., Sui, Y., Li, F., & Yin, H. (2021). Management of open calcaneal fractures with medial wounds by one-stage sequential reduction and frame structure fixation using percutaneous Kirschner wires. Orthopaedic Surgery, 13(1), 225–236. https://doi.org/10.1111/os.12902

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cursaru, A., Crețu, B., Șerban, B., et al. (2022). Minimally invasive treatment and internal fixation vs. extended lateral approach in calcaneus fractures of thalamic interest. Experimental and Therapeutic Medicine, 23(3), 196. https://doi.org/10.3892/etm.2022.11119

    Article  PubMed  PubMed Central  Google Scholar 

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Bandyopadhyay, A., Kumar, S. & Mandal, P. Calcaneal Fractures Management, Change of Clinical Practice in Recent Years from ELA to STA: A Systematic Review and Meta-Analysis. JOIO 57, 800–817 (2023). https://doi.org/10.1007/s43465-023-00871-0

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