Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis

Mehta, Cyrus R.; An, Vincent V.G.; Phan, Kevin; Sivakumar, Brahman; Kanawati, Andrew; Suthersan, Mayuran

doi:10.1186/s13018-018-0943-6

Cited by 53 publications

(36 citation statements)

References 32 publications

(23 reference statements)

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“…Calcaneus fractures are commonly seen injuries in the fracture of foot. Previous studies have stated that calcaneus factures accounted for 1 to 4% of all adult fractures [ 1 , 2 ], and 60–80% are displaced intra-articular calcaneus fractures (DIACFs) [ 1 – 4 ]. Calcaneus fractures especially DIACFs were mainly caused by an axial loading mechanism, which is directed through the somewhat laterally situated calcaneal tuberosity.…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of surgical site infection after ORIF in calcaneus fractures, a retrospective cohort study

2018

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BackgroundOccurrence of calcaneus fractures is on the up trend. Owing to its unique anatomical morphology and limited soft-tissue envelope, management of calcaneus fractures is a challenge to the orthopaedic surgeon, and surgical site infection (SSI) is one of the serious postoperative complications. In order to decrease the incidence of wound breakdown and improve clinical outcomes, it is necessary to understand which factors were associated with SSI. The aim of this study was to identify predictors of SSI and quantify the incidence of SSI in calcaneus fractures following open reduction and internal fixation (ORIF).MethodsThis retrospective study was performed at a level 1 trauma center from January 2014 to June in 2017. Data of adult patients with calcaneus fractures treated by ORIF were extracted from the electronic medical records. A total of 681 patients were collected. We reviewed the patients’ demographics, characteristics of fracture, treatment-related variables, and indexes of laboratory examination. Univariate and multivariate logistic analysis models were performed respectively to determine independent predictors of SSI.ResultsSixty-six patients developed SSI in this study. The overall incidence of SSI after ORIF of calcaneus fracture was 9.7%, with 2.9% for deep infection and 6.8% for superficial SSI. Independent predictors of SSI identified by multivariate analysis were open fracture (odds ratio = 9.48, 95% CI = 4.53–19.85, P = 0.00007), high-energy injury (odds ratio = 2.07, 95% CI = 1.16–3.70, P = 0.01437), ASA class 3 or higher (odds ratio = 3.50, 95% CI = 1.18–10.37, P = 0.02401), and intraoperative temperature < 36.0 °C (odds ratio = 1.69, 95% CI = 1.13–2.28, P = 0.04410).ConclusionThe SSI incidence was high (9.7%) for calcaneus fractures following ORIF. External fixation plays an important role in the treatment of severely displaced and depressed intra-articular or open calcaneus fractures. Increased ASA class and intraoperative hypothermia were associated with wound breakdown, and elaborative evaluation of fracture and soft-tissue damage was vitally necessary in this at-risk population.

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Section: Introductionmentioning

confidence: 99%

Incidence and predictors of surgical site infection after ORIF in calcaneus fractures, a retrospective cohort study

2018

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“…A total of 100 articles were found and were finalized to include five articles in the study. 15,16,25 –27 These five meta-analyses were published in 2017 and 2018. The characteristics of the included literature are presented in Table 1. The characteristics of the original studies in the literature are presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses

Xiong

Kang

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Accumulated literature has reported the comparative efficacy of the sinus tarsi approach (STA) and the extensile lateral approach (ELA) for the treatment of calcaneal fractures (CFs). However, the best alternative treatment for CF is still inconsistent. Herein, the present systematic review of overlapping meta-analyses aims to achieve an evident conclusion by performing a comprehensive reanalysis of previous meta-analyses regarding the comparison of the STA and the ELA. Methods: We searched several databases, including Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov , OVID, and CNKI for the meta-analyses comparing the STA and the ELA for the treatment of CF. All related meta-analyses of randomized controlled trials and cohort studies were included. Two researchers independently assessed the quality of the articles and extracted the data. The Jadad decision algorithm was used to evaluate the evidence of the articles. Results: Ultimately, five meta-analyses were included in the present study. The Assessment of Multiple Systematic Reviews scores of these articles ranged from 5 to 9 with a median of 7. The analysis of best quality, Bai 2018, was selected based on the Jadad algorithm. In this article, the significant differences were found in wound complications and operating time, recovery of Böhler’s angle, the American Orthopaedic Foot and Ankle Society scores, and the visual analog scale. Conclusion: The clinical relevance of the present study is that both the STA and the ELA are effective in alleviating pain and improving functionality in the treatment of CF. However, due to a shorter operation duration and lower complication rates, the STA was indicated to be a superior alternative for CF treatment.

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“…For these reasons, minimally invasive techniques involving a sinus tarsi approach under fluoroscopic guidance with plates, screws, and/or K-wire fixation have become more frequent, with decreased rates of complication. 52 Sural nerve injury is another relatively common complication of traditional surgeries, as is compartment syndrome that can occur in up to 10% of cases. 52,53 Postoperative imaging should be utilized to assess for evidence of deep tissue infection including osteomyelitis and for hardware fracture or loosening.…”

Section: Calcaneal Fracturesmentioning

confidence: 99%

“…52 Sural nerve injury is another relatively common complication of traditional surgeries, as is compartment syndrome that can occur in up to 10% of cases. 52,53 Postoperative imaging should be utilized to assess for evidence of deep tissue infection including osteomyelitis and for hardware fracture or loosening. Patients with diabetes, smokers, and those with open injuries have higher rates of perioperative infection.…”

Section: Calcaneal Fracturesmentioning

confidence: 99%

Radiologic Evaluation of Lower Leg, Ankle, and Foot Fracture Fixation Hardware

Mar

Schilling

Lomasney

et al. 2019

Semin Musculoskelet Radiol

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Radiologists should be familiar with basic principles of fracture fixation and the normal imaging appearances of implant constructs and their complications. The surgeon's selection of external fixation, intramedullary nail fixation, open reduction and internal fixation, or some combination depends on patient factors, fracture configuration, injury to the soft tissue envelope, and surgeon experience. Complications including loss of fixation with resultant malalignment, nonunion, infection, and posttraumatic osteoarthritis present additional challenges for the surgeon as well as the radiologist. This article reviews the rationale behind fracture fixation in fractures of the lower leg, ankle, and foot. Examples of postoperative complications are also reviewed.

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Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis

Cited by 53 publications

References 32 publications

Incidence and predictors of surgical site infection after ORIF in calcaneus fractures, a retrospective cohort study

Incidence and predictors of surgical site infection after ORIF in calcaneus fractures, a retrospective cohort study

Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses

Radiologic Evaluation of Lower Leg, Ankle, and Foot Fracture Fixation Hardware

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