Cannulated screw fixation versus plate fixation in treating displaced intra-articular calcaneus fractures: a systematic review and meta-analysis

BACKGROUND

Operative treatment has become the current trend for displaced intra-articular calcaneus fracture (DIACF), while using cannulated screw fixation or plate fixation is still controversial for treating DIACF. The purpose of this meta-analysis is to compare the outcome of the two fixation methods.

METHODS

We searched literature comparing cannulated screw fixation and plate fixation from PubMed, Embase, Web of Science, and Cochrane Library. Only randomized controlled trials were included. The outcomes of post-operative function, radiological measurement, time efficiency, and wound complications were pooled in the meta-analysis.

RESULT

Seven RCTs with 902 cases of DIACF were included. Pooled results showed the two fixation methods that had similar function satisfactory of AOFAS score (RR = 0.95, 95% CI = [0.83, 1.09], P = 0.47, I² = 0%) and Maryland Foot score (RR = 0.93, 95% CI = [0.68, 1.28], P = 0.66, I² = 84%). Compared to plate fixation, cannulated screw fixation had better improvement of Bohler's angle (WMD = 0.56, 95% CI = [0.20, 0.91], P = 0.002, I² = 34%) and Gissane's angle (WMD = 1.36, 95% CI = [0.56, 2.16], P = 0.0008, I² = 7%), better recovery of calcaneal height (WMD = 0.49, 95% CI = [0.02, 0.95], P = 0.04, I² = 6%), shorter time to operation (WMD =  - 2.91, 95% CI = [- 4.99, - 0.84], P = 0.006, I² = 97%), less operation time (WMD =  - 21.58, 95% CI = [- 37.31, - 5.85], P = 0.007, I² = 98%), reduced length of hospital stay (WMD =  - 2.00, 95% CI = [- 3.69, - 0.31], P = 0.02, I² = 97%), and less wound complications (RR = 0.16, 95% CI = [0.08, 0.32], P < 0.00001, I² = 0%).

CONCLUSION

Cannulated screw fixation and plate fixation have similar postoperative functional satisfactory. Cannulated screw fixation is superior to plate fixation in reduction quality, time efficiency, and wound complications.

Sinus Tarsi Approach with Subcutaneously Delivered Plate Fixation for Displaced Intra-Articular Calcaneal Fractures

Displaced intra-articular calcaneal fractures can be treated with open reduction and internal fixation through various methods, including the extensile lateral approach, sinus tarsi approach, percutaneous reduction and fixation, external fixation, and calcaneoplasty. Although the gold standard is the extensile lateral approach, this method has significant wound-healing complications associated with it. Literature shows that the reduction achieved through minimally invasive techniques is equal to that achieved with the extensile lateral approach, while reducing the amount of postoperative complications. This article outlines a technique that uses the sinus tarsi approach with subcutaneous plate fixation.

Cannulated screw fixation and plate fixation for displaced intra-articular calcaneus fracture: A meta-analysis of randomized controlled trials

BACKGROUND

Displaced intra-articular calcaneus fractures (DIACFs) are the most common type of calcaneus fracture. The differences in therapeutic effectiveness between cannulated screw fixation (CSF) and plate fixation are still unclear. Thus, in this meta-analysis, we evaluated the therapeutic effectiveness of these two fixation methods.

MATERIALS AND METHODS

We searched for all publications on DIACFs fixated with cannulated screws or plates in the following electronic databases: Pubmed, Cochrane, Embase and CNKI. Only randomized controlled studies were included. The Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0) was applied for analysis. The primary outcomes were American Orthopedic Foot and Ankle Society score (AOFAS), improvement of Bohler's angle, improvement of Gissane's angle and the width of the calcaneus. Outcomes were reported as the standard mean difference (SMD) or relative risk (RR) with the 95% confidence interval (CI). A random effects model was used to assess the pooled data.

RESULTS

Five randomized controlled studies met our inclusion criteria, and a total of 707 patients were involved. There was no statistically significant difference between the cannulated screw fixation group and the plate fixation group in terms of excellent and good AOFAS scores (RR = 1.01, 95%CI 0.91 to 1.13, P = 0.79), improvement of Bohler's angle (SMD = 0.12, 95%CI -0.03 to 0.28, P = 0.12), improvement of Gissane's angle (SMD = 0.09, 95%CI -0.28 to 0.26, P = 0.30), or the width of the calcaneus (SMD = -0.07, 95%CI -0.24 to 0.10, p = 0.45). Compared with plate fixation, CSF showed a significant reduction in the duration of surgery (SMD = -1.74, 95%CI, -3.35 to -0.13, P = 0.03) and rate of complications (RR = 0.25, 95%CI, 0.15 to 0.44, P＜0.00001).

CONCLUSIONS

Cannulated screw fixation and plate fixation have similar fixation effectiveness and functional outcomes in the treatment of displaced intra-articular calcaneus fractures. Due to the shorter duration of surgery and low rate of complications, cannulated screw fixation is superior to plate fixation. However, further studies are needed to evaluate cannulated screw fixation for various Sanders types of calcaneus fractures.