Operative vs nonoperative treatment of displaced intra-articular calcaneal fracture: A meta-analysis of randomized controlled trials

Table 1 Detailed assessment items of modified Jadad scale

Item assessed	Response	Score
Was the study described as randomized?	Yes	1
	No	0
Was the method of randomization appropriate?	Yes	1
	No	-1
	Not described	0
Was the study described as blinded?1	Yes	1
	No	0
Was the method of blinding appropriate?	Yes	1
	No	-1
	Not described	0
Was there a description of withdrawals and dropouts?	Yes	1
	No	0
Was there a clear description of the inclusion/exclusion criteria?	Yes	1
	No	0
Was the method used to assess adverse effects described?	Yes	1
	No	0
Was the method of statistical analysis described?	Yes	1
	No	0

¹Double-blind RCTs 1 score; single-blind RCTs 0.5 score. RCTs: Randomized controlled trials.

Table 2 General information of eligible randomized controlled trials

Ref.	location	Cases	Sex ratio	Mean age	Follow-up time	Main outcome measures
		(O/N)	(M/F)	(O/N) (yr)	(O/N) (yr)
Parmar et al[6]	England	25/31	48/8	48.3/48.8	2.1/1.8	Pain level, site, pattern; walking problems; shoe wear; resuming pre-injury job; deformity; ankle and subtalar movement; foot function; complications
O’Farrell et al[27]	Ireland	12/12	20/4	33/38	1.3/1.2	Shoe wear; pain-free walking distance; resuming pre-injury job; restoration of BÖhler angle and Gissane angle; motion range of ankle, subtalar and calcaneocuboid
Chrintz et al[26]	Denmark	33/35	NR	NR	1.5/1.5	Radiography outcomes
Thordarson et al[7]	United States	15/11	21/5	35/36	1.4/1.2	Functional assessment scale; motion rage of subtalar and ankle; gait analysis; restoration of BÖhler angle; pain; daily activity; shoe wear; walking; exercise; work; complications
Buckley et al[8]	Canada	206/218	381/43	41/39	3.0/3.0	Complications; SF-36 scale; VAS; shoe wear; numbness
Ibrahim et al[9]	United Kingdom	15/11	21/5	61/58	15.2/14.8	AOFAS score; FFI score; calcaneal fracture score; restoration of BÖhler angle and calcaneal height; arthritic grading of the subtalar joint
Nouraei et al[16]	Iran	31/30	NR	46/52	3.0/3.0	Motion range of ankle and subtalar; X-ray findings; width of heel; pain in walking; shoe wear; swelling of foot and ankle; reflex systematic dystrophy
Agren et al[15]	Sweden	42/40	59/23	49/48	10 (8-12)1	VAS; SF-36 scale; AOFAS score; OM scale; complications

¹Mean follow-up time was 10 yr with range of 8-12 yr. NR: Not reported; O/N: Operative group/non-operative group; M/F: Male/female; SF-36: Short-form-36 health survey; VAS: Visual analogue scale; AOFAS: American Orthopaedic Foot and Ankle Society; FFI: Foot function index; OM: Olerud-Molander.

Table 3 Methodological assessment of eligible randomized controlled trials using modified Jadad scale

Item assessed	Parmar 1993	O’Farrell 1993	Chrintz 1993	Thordarson 1996	Buckley 2002	Ibrahim 2007	Nouraei 2011	Agren 2013
Was the study described as randomized?	√	×	√	√	√	√	√	√
Was the method of randomization appropriate?	?	?	?	√	√	?	?	√
Was the study described as blinded?	×	×	×	√	√	×	×	√
Was the method of blinding appropriate?	?	?	?	?	?	?	?	?
Was there a description of withdrawals and dropouts?	×	√	√	√	√	√	√	√
Was there a clear description of the inclusion/exclusion criteria?	×	×	√	√	√	√	√	√
Was the method used to assess adverse effects described?	×	×	×	×	√	×	×	×
Was the method of statistical analysis described?	√	√	√	√	√	√	√	√
Total score	2	2	4	5.5	6.5	4	4	5.5

√: Yes; ×: No; ?: Not described.

Table 4 Results of sensitivity analysis

Outcomes	All eligible RCTs included					Only high score RCTs included
	n	Patients	I2	RR (95%CI)	P values	n	Patients	I2	RR (95%CI)	P values
Resume pre-injury job	3	106	55%	1.53 (1.13, 2.07)	0.006	1	26	NA	2.20 (0.97, 5.00)	0.06
Residual pain	3	143	80%	0.73 (0.40, 1.36)	0.33	2	87	93%	0.63 (0.19, 2.11)	0.45
Shoe fitting problems	6	667	63%	0.61 (0.37, 1.04)	0.07	4	587	73%	0.57 (0.27, 1.21)	0.15
Limited walking distance	2	82	71%	0.88 (0.57, 1.36)	0.56	1	26	NA	0.42 (0.16, 1.08)	0.07
Complications	4	588	0%	1.60 (1.17, 2.18)	0.003	3	532	1%	1.59 (1.14, 2.22)	0.006

NA: Not applicable; RCTs: Randomized controlled trials.