Treatment of displaced intra-articular calcaneal fractures with cannulated screws and plates: A metaanalysis of 15 randomized controlled trials / 中国组织工程研究

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%CI0.27-1.10, P=0.001) and Gissane’s angle (MD=0.95, 95%CI0.16-1.74, 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%CI0.19-0.41, 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.