Transtarsal sinus incision and traditional L-shaped incision for calcaneal fractures: A systematic evaluation and meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND: Calcaneal fractures account for approximately 60% of all tarsal fractures, and 75% of calcaneal fractures are intra-articular. Surgical treatment can restore the shape and function of calcaneus well. In recent years, transtarsal sinus incision has been recognized and applied by clinicians, but the choice of surgical approach for calcaneal fractures is still controversial. OBJECTIVE: To systematically evaluate the efficacy and surgical safety of transtarsal sinus incision and traditional L-shaped incision in the treatment of calcaneal fracture. METHODS: PubMed, Cochrane, EMbase, CNKI, VIP and Wanfang databases were searched by computer for all randomized controlled trials comparing transtarsal sinus incision with traditional L-shaped incision in the treatment of calcaneal fractures. The retrieval time was from the establishment of the database to April 2019. The meta-analysis was carried out with RevMan 5.3 software after literature screening and data extraction based on inclusion criteria and exclusion criteria. RESULTS AND CONCLUSION: (1) A total of 522 patients were enrolled in 7 randomized controlled trials. (2) Meta-analysis results showed that there was no significant difference in Bohler angle [MD=0.14, 95%CI (-0.54, 0.81), P > 0.05], Gissane angle [MD=-0.19, 95%CI (-1.36, 0.98), P > 0.05] and Maryland score [MD=-0.25, 95%CI (-3.41, 2.91), P > 0.05] between the two incisions at the last follow-up. (3) American Orthopaedic Foot and Ankle Society score [MD=6.39, 95%CI(-0.09, 12.87), P=0.05] might be different. (4) Compared with the traditional L-shaped incision, the tarsal sinus incision had certain advantages in shortening the operation time [MD=-14.98, 95%CI (-23.90, -6.06), P=0.001 < 0.05], and lower incidence of postoperative complications [OR=0.18, 95%CI (0.08, 0.38), P < 0.000 1]. (5) For Sanders II and III calcaneal fractures, the transtarsal sinus incision has no obvious advantage over the traditional L-shaped incision in terms of curative effect. However, because the transtarsal sinus incision has a relatively small wound, it has the advantages of relatively short operation time and relatively low incidence of complications after operation. This suggests that the tarsal sinus incision is safe. However, due to the small sample size of the included study, the above conclusions still need to be verified by clinical trials with higher quality and larger sample size.