Protective Effect of Surgery Against Early Subtalar Arthrodesis in Displaced Intra-articular Calcaneal Fractures

Abstract

The aim of this study is to determine whether surgery offers protection against early subtalar arthrodesis in displaced intraarticular calcaneal fractures.Systematic review and meta-analysis: searches of electronic databases 1980 to August 2014, checking of reference lists, hand searching of journals, and contact with experts. Randomized controlled trials (RCTs) in which surgical treatment was compared with nonsurgical treatment of displaced intra-articular calcaneal fractures from 1980 to 2014. The modified Jadad scale was used for trial quality and effective data were pooled for meta-analysis. Study results related to early subtalar arthrodesis were extracted and risk assessment was combined with surgical treatment and nonsurgical treatment.The primary analysis included 4 studies and 966 participants. The estimated overall risk ratio was 4.40 (95% confidence interval 2.67–7.39), indicating the incidence of early subtalar arthrodesis in nonsurgical group is 4.4 times the surgical group. The results showed that surgical treatment was superior to nonsurgical treatment in protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures (Z = 5.600, P < 0.001).Surgery offers protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures.

Medial external fixation for staged treatment of closed calcaneus fractures: Surgical technique and case series

“…[20][21][22] Surgical reduction of the articular surface has been demonstrated to reduce rates of subtalar arthritis compared to nonoperative management. 18 Baumgaertel and several other studies have demonstrated early external fixation as an effective mode for restoring calcaneal morphology, consistent with our experience. 4,23,24 Magnan et al argued that restoration of normal calcaneal architecture is more important than articular reduction and can be accomplished with external fixation alone.…”

“…[12][13][14][15][16][17] Benefits include improved clinical outcomes, reduced subtalar arthritis, and decreased need for complex secondary surgeries compared to nonoperative management. 18,19 When surgery is recommended, the two goals of treatment are (1) restoration of calcaneal morphology and (2) anatomic reduction of the involved articular surfaces. Restoring calcaneal morphology mitigates late problems associated with calcaneal malunion including anterior tibiotalar impingement, subfibular impingement, gait abnormality, and adjacent joint degeneration.…”

Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

“…But a basic conclusion supported by certain randomized controlled trials (RCTs) [ 4 , 5 ] and even many meta-analysis [ 6 – 8 ] has been drawn that surgical treatment can better reconstruct the anatomy of the calcaneus but bring a higher incidence of complications compared with the nonsurgical treatment. Surgical treatment can also lower the subtalar fusion rate and offer protection against early subtalar arthrodesis in DIACFs [ 7 , 9 ].…”

Treatment of displaced intra-articular calcaneus fractures: a current concepts review

“…However, almost all studies cite insufficient evidence to make a recommendation. Others like Zhang et al [ 16 ], Luo et al [ 17 ] and Liu et al [ 18 ] have stated that surgical interventions in the hands of experienced surgeons have better outcomes and less subtalar fusions are subsequently required.…”

“… Insufficient evidence for recommendations. Liu et al 2015 [ 18 ] 966 patients. Surgery protects against subtalar arthrodesis.…”