Treatment of displaced intra-articular calcaneal fractures with cannulated screws and plates: a meta-analysis of 15 randomized controlled trials

doi:10.3969/j.issn.2095-4344.3766

Abstract

Abstract: OBJECTIVE: Displaced intra-articular calcaneal fractures are the most common type of calcaneal fracture. Cannulated screw fixation and plate fixation are commonly used methods. However, the differences in therapeutic effectiveness between cannulated screw fixation and plate fixation are still unclear. Thus, this study compared the effect of percutaneous cannulated screw fixation and plate fixation in the treatment of intra-articular calcaneal fractures.
METHODS: The authors searched for randomized controlled trials on displaced intra-articular calcaneal fractures fixated with cannulated screws or plates in the following electronic databases: PubMed, Cochrane Library, Embase, Web of Science, and CNKI. The retrieval time limit was from the establishment of the database to December 2019. The retrieved literatures were screened according to inclusion and exclusion criteria. Quality evaluation was performed to extract effective data. Meta-analysis was conducted using RevMan 5.3 software.
RESULTS: Fifteen randomized controlled studies were included with 1 438 patients with calcaneal fractures. The risk bias evaluation of the included literature showed that the overall quality of literature was above average. Meta-analysis results show that (1) plate fixation group was better than cannulated screw fixation group in terms of Bohler’s angle (MD=0.69, 95%CI:0.27-1.10, P=0.001) and Gissane’s angle (MD=0.95, 95%CI:0.16-1.74, P=0.02) (P < 0.05). (2) Compared with plate fixation, cannulated screw fixation showed a significant reduction in the operation time (MD=-23.92, 95%CI: -25.40 to -22.44, P < 0.000 01) and postoperative complications (OR=0.28, 95%CI:0.19-0.41, P < 0.000 01) (P < 0.05). (3) There was no statistically significant difference between the cannulated screw fixation group and the plate fixation group in terms of calcaneal height (MD=0.43, 95%CI:-0.17-1.03, P=0.16) and AOFAS score (MD=0.61, 95%CI:-0.35-1.58, P=0.21).
CONCLUSION: Above data concluded that Bohler’s and Gissane’s angles in the plate fixation group are better than those in the cannulated screw fixation group, while the cannulated screw fixation technology has the advantages of short operation time and low complication rate.

Key words: bone, fracture, calcaneus, intra-articular fracture, screw, internal fixation, plate, meta-analysis

CLC Number:

Hu Kai, Qiao Xiaohong, Zhang Yonghong, Wang Dong, Qin Sihe. Treatment of displaced intra-articular calcaneal fractures with cannulated screws and plates: a meta-analysis of 15 randomized controlled trials[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1465-1470.

Figures/Tables 11

References

[1] EASTWOOD DM, GREGG PJ, ATKINS RM. Intra-articular fractures of the calcaneum. Part I: Pathological anatomy and classification. J Bone Joint Surg Br. 1993;75(2):183-188.
[2] MITCHELL MJ, MCKINLEY JC, ROBINSON CM. The epidemiology of calcaneal fractures. Foot. 2009; 19(4):197-200.
[3] POTER MQ, NUNLEY JA. Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2009;91(8):1854-1860.
[4] VAN TETERING EAA, BUCKLEY RE. Functional Outcome (SF-36) of Patients with Displaced Calcaneal Fractures Compared to SF-36 Normative Data. Foot Ankle Int. 2004;25(10):733-738.
[5] GOTHA HE, ZIDE JR. Current controversies in management of calcaneus fractures. Orthop Clin North Am. 2017;48(1):91-103.
[6] BUCKLEY R. OperatⅣe care did not benefit closed, displaced,intra-articular calcaneal fractures. J Bone Joint Surg Am. 2015;97(4):341.
[7] SHARR PJ, MANGUPPLI MM, WINSON IG, et al. Current management options for displaced intra-articular calcaneal fractures: nonoperative, ORIF, minimally invasⅣe reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review. Foot Ankle Surg. 2016; 22(1):1-8.
[8] ABDELGAWAD AA, KANLIC E. Minimally invasive (sinus tarsi) approach for open reduction and internal fixation of intraarticular calcaneus fractures in children: surgical technique and case report of two patients. J Foot Ankle Surg. 2015; 54(1):135-139.
[9] ARASTU M, SHEEHAN B, BUCKLEY R. Minimally invasive reduction and fixation of displaced calcaneal fractures: surgical technique and radiographic analysis. Int Orthop. 2014;38(3):539-545.
[10] NOSEWICZ T, KNUPP M, BARG A, MASS M, et al. Mini-open sinus tarsi approach with percutaneous screw fixation of displaced calcaneal fractures. Foot Ankle Int. 2012;33(11):925-933.
[11] CHEN L, ZHANG G, HONG J, et al. Comparison of percutaneous screw fixation and calcium sulfate cement grafting versus open treatment of displaced intra-articular calcaneal fractures. Foot Ankle Int. 2011;32(10):979-985.
[12] WANG Q, LI X, SUN Y, et al. Comparison of the outcomes of two operational methods used for the fixation of calcaneal fracture. Cell Biochem Biophys. 2015;72(1):191-196.
[13] SAMPATH KV, MARIMUTHU K, SUBRAMANI S, et al. Prospective randomized trial comparing open reduction and internal fixation with minimally invasive reduction and percutaneous fixation in managing displaced intra-articular calcaneal fractures. Int Orthop. 2014;38(12):2505-2512.
[14] 唐进军.微创空心螺钉内固定与钢板内固定治疗跟骨骨折的临床思路构建[J].大家健康(学术版),2014,8(13):153-154.
[15] FENG Y, SHUI X, WANG J, et al. Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial. BMC Musculoskeletal Disorders. BMC Musculoskelet Disord. 2016;17(1):288.
[16] LU D, ZHU SY, YANG J, et al. A comparison of two minimally invasive procedures for intra-articular displaced calcaneal fractures in older children. Acta Orthop Belg. 2016;82(4):779-786.
[17] 廖文利,何久盛,曹立峰.经皮撬拨复位空心螺钉与切开复位钢板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的比较[J].临床骨科杂志,2019, 22(4):492-495.
[18] 王照东,官建中,吴敏,等.经皮撬拨复位空心螺钉内固定和切开复位钢板内固定治疗跟骨骨折疗效比较[J].淮海医药,2018,36(3):286-289.
[19] 刘耀辉,李雪林,陈小微,等.跗骨窦小切口结合空心螺钉与L型切口结合钢板内固定治疗SandersⅢ型跟骨骨折疗效比较[J].世界复合医学,2017,3(4):9-12,16.
[20] 邱剑斌.微创空心螺钉内固定及钢板内固定手术治疗40例跟骨骨折患者的临床效果评价[J].中外医学研究,2017,15(31):169-170.
[21] 黄世超,倪锋,魏广奇,等.经皮撬拨复位空心螺钉与切开复位钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折疗效比较[J].中国临床研究, 2017,30(6):813-815.
[22] 巩文庆,曹溢.微创撬拨复位空心拉力螺钉固定与钢板内固定治疗SandersⅡ型、Ⅲ型跟骨骨折的疗效分析[J].中国实用医药,2016, 11(33):4-6.
[23] 赵志,吴敏,肖玉周,等.经皮撬拔空心钉固定与“L”型切口治疗跟骨骨折的临床疗效[J].中国矫形外科杂志,2016,24(6):495-499.
[24] 张昊,张金金,张普,等.不同固定方法对跟骨骨折的临床治疗效果研究[J].黑龙江医药,2016, 29(1):112-113.
[25] 张国辉.闭合复位空心螺钉固定与切开复位钢板固定治疗跟骨骨折临床疗效比较[J].海军医学杂志,2015,36(3):227-229.
[26] COTTOM JM, BAKER JS. Restoring the anatomy of calcaneal fractures: a simple technique with radiographic review. Foot Ankle Spec. 2017;10(3): 235-239.
[27] DIRANZO-GARCíA J, BERTó-MARTí X, CASTILLO-RUIPEREZ L, et al. Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures. Rev Esp Cir Ortop Traumatol. 2018. Doi: 10.1016/j.recot.2018.01.010.
[28] HARVEY EJ, GRUJIC L, EARLY JS, et al. Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int. 2001;22:868-873.
[29] PASTIDES PS, MILNES L, ROSENFELD PF. Percutaneous arthroscopic calcaneal osteosynthesis: a minimally invasive technique for displaced intra-articular calcaneal fractures. J Foot Ankle Surg. 2015;54(5):798-804.
[30] 张青山,张蜀华.两种手术治疗Sanders Ⅱ型、Ⅲ型跟骨骨折的比较[J].实用骨科杂志, 2014, 20(6):515-519.
[31] 李景光,陈先进,吕维宝,等.经皮撬拨复位空心螺钉与切开复位钢板内固定治疗 Sanders Ⅱ、Ⅲ型跟骨骨折的比较[J].中国矫形外科杂志,2016,24(16):1449-1455.
[32] 王金辉.微创空心螺钉内固定和钢板内固定治疗跟骨骨折的临床观察[J].中国继续医学教育, 2016,8(11):165-166.
[33] SMEREK JP, KADAKIA A, BELKOFF SM, et al. Percutaneous screw configuration versus perimeter plating of calcaneus fractures: a cadaver study. Foot Ankle Int. 2008;29(9):931-935.
[34] ZHAO W, ZHANG Y. Comparison and predictive factors analysis for efficacy and safety of Kirschner wire, anatomical plate fixation and cannulated screw in treating patients with open calcaneal fractures. Medicine (Baltimore). 2019;98(43):e17498.
[35] PENG Y, LIU J, ZHANG G, et al. Reduction and functional outcome of open reduction plate fixation versus minimally invasive reduction with percutaneous screw fixation for displaced calcaneus fracture: a retrospective study. J Orthop Surg Res. 2019;14(1):124.
[36] NI M, WONG DWC, MEI J, et al. Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intraarticular calcaneal fractures. Sci China Life Sci. 2016;59(9):958-964.
[37] ZHANG G, DING S, RUAN Z. Minimally invasive treatment of calcaneal fracture. J Int Med Res. 2019;47(8):3946-3954. .
[38] VICENTI G, CARROZZO M, SOLARINO G, et al. Comparison of plate, calcanealplasty and external fixation in the management of calcaneal fractures. Injury. 2019;50 Suppl 4:S39-S46.
[39] RAMMELT S, AMLANG M, BARTHEL S, et al. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res. 2010;468(4):983-990.
[40] STAPLETON JJ, ZGONIS T. Surgical Treatment of Intra-articular Calcaneal Fractures. Clin Podiatr Med Surg. 2014;31(4):539-546.
[41] TOMASZ N, MARKUS K, ALEXEJ B, et al. Mini-open sinus tarsi approach with percutaneous screw fixation of displaced calcaneal fractures: a prospective computed tomography-based study. Foot Ankle Int. 2012;33(11):925-933.
[42] PITTS CC, ALMAGUER A, WILSON JT, et al. Radiographic and postoperative outcomes of plate versus screw constructs in open reduction and internal fixation of calcaneus fractures via the sinus tarsi. Foot Ankle Int. 2019;40(8):929-935.
[43] DEWALL M, HENDERSON CE, MCKINLEY TO, et al. Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures. J Orthop Trauma. 2010;24(8):466-472.
[44] DAWS SB, NEARY K, LUNDEEN G. Short-term radiographic outcomes of calcaneus fractures treated with 2-incision, minimally invasive approach. Foot Ankle Int. 2019;40(9):1060-1067.
[45] TENNENT TD, CALDER PR, SALISBURY RD, et al. The operative management of displaced intra-articular fractures of the calcaneum: a two-centre study using a defined protocol. Injury. 2001;32(6):491-496.
[46] JACQUOT F, ATCHABAHIAN A, et al. Balloon reduction and cement fixation in intra-articular calcaneal fractures: a percutaneous approach to intra-articular calcaneal fractures. Int Orthop. 2011;35(7):1007-1014.