Jiang N, Song HJ, Xie GP, Wang L, Liang CX, Qin CH, Yu B. Operative vs nonoperative treatment of displaced intra-articular calcaneal fracture: A meta-analysis of randomized controlled trials. World J Meta-Anal 2015; 3(1): 61-71 [DOI: 10.13105/wjma.v3.i1.61]
Corresponding Author of This Article
Dr. Bin Yu, Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou 510515, Guangdong Province, China. nanfanghot@126.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Meta-Anal. Feb 26, 2015; 3(1): 61-71 Published online Feb 26, 2015. doi: 10.13105/wjma.v3.i1.61
Operative vs nonoperative treatment of displaced intra-articular calcaneal fracture: A meta-analysis of randomized controlled trials
Nan Jiang, Hui-Juan Song, Guo-Ping Xie, Lei Wang, Chang-Xiang Liang, Cheng-He Qin, Bin Yu
Nan Jiang, Guo-Ping Xie, Lei Wang, Chang-Xiang Liang, Cheng-He Qin, Bin Yu, Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Hui-Juan Song, Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Chang-Xiang Liang, Department of Orthopaedics, Guangdong General Hospital Affiliated to Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Jiang N and Song HJ contributed equally to this study; Jiang N contributed to study design, data analysis and interpretation, manuscript drafting and revision, statistical analysis support; Song HJ contributed to literature search, data acquisition and analysis, manuscript drafting; Xie GP contributed to data acquisition, interpretation and statistical analysis; Wang L contributed to literature search and data acquisition; Liang CX contributed to literature search and methodology assessment of included studies; Qin CH contributed to data acquisition and interpretation, methodology assessment of included studies and statistical analysis; Yu B contributed to study design, data interpretation, manuscript drafting and revision, statistical analysis support and supervision.
Conflict-of-interest: The authors have declared that no competing interests exist.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at nanfanghot@126.com. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Bin Yu, Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou 510515, Guangdong Province, China. nanfanghot@126.com
Telephone: +86-20-61641741 Fax: +86-20-61360066
Received: October 17, 2014 Peer-review started: October 18, 2014 First decision: December 3, 2014 Revised: December 8, 2014 Accepted: December 18, 2014 Article in press: December 19, 2014 Published online: February 26, 2015 Processing time: 94 Days and 22.8 Hours
Abstract
AIM: To investigate clinical efficacy of displaced intra-articular calcaneal fracture (DIACF) following operation and nonoperation.
METHODS: Literature search was performed of PubMed and Cochrane Library by two independent authors to identify randomized controlled trials (RCTs) comparing operative vs nonoperative treatment of DIACF from inception to December 31st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or random-effects models were adopted with P > 0.05 or P≤ 0.05 for heterogeneity tests, respectively.
RESULTS: Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job (P = 0.006). No statistical differences were found between the two groups in residual pain (P = 0.33), shoe fitting problems (P = 0.07), limited walking distance (P = 0.56) or secondary late arthrodesis (P = 0.38). However, operative treatment was associated with a higher complication rate (P = 0.003). Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems (P < 0.0001) in operative group, the two groups had similar complication rate in deep wound infection (P = 0.34), compartment syndrome (P = 0.46), thromboembolism (P = 0.32), reflex sympathetic dystrophy (P = 0.51) or traumatic arthritis secondary to DIACF (P = 0.43).
CONCLUSION: Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.
Core tip: This updated meta-analysis regarding the optimal treatment of displaced intra-articular calcaneal fracture suggests that operative and nonoperative treatment have similar clinical outcomes in residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis. However, operative treatment has a higher complication risk than nonoperative treatment.
