Operative Versus Nonoperative Treatment Of Displaced Intra-articular Calcaneal Fracture:a Meta-analysis

BackgroundCalcaneus is the largest tarsal bone, it’s irregular hexahedral,beloid.The calcaneus is very in human’s activity,and it can undertake almost45%weight of a man.There are four facies articularis in calcaneus,three facies articularis surface,they are anterior articular surface for talus,posterior articular surface for talus and middle articular surface for talus,these three are respectively connectde with the anterior%posterior and middle articular surface for calcaneus and Composition of the subtalar joint, in front of the articular surface and the cuboid form calcaneocuboid joint..Calcaneal is mainly composed of cancellous bone, density is different, the subcutaneous tissue is thinner in lateral.a nodule in front is fibular trochlea, there are peroneus longus tendon and peroneus brevis tendon below and above respectively through in a helical groove. The inner side of the subcutaneous soft tissue is thick, get by neurovascular bundle, and the Bone surface is looks like arc depression。 The integrity of the calcaneus anatomy to ensure the normal order of the weight of lower limb stress, and it is important to keep the hind foot’s normal function and support form of arch. Calcaneal fractures are the most common type of tarsal bone fracture, account for approximately60%of the tarsal fracture, approximatelyl%-2%of all fractures.Calcaneal fractures occur in the industrial workers,most of them are closed fractures,the cause of this injury is common in falls from a height,and also happen by traffic injury and others.Because the heel shape is irregular,the surrounding tissue anatomical structure is complex,Patients with fractures may lose labor ability completely up to3-5years.More serious,calcaneal fractures with poor prognosis and high rate of disability.Therefore appropriate clinical classification and treatment effect on the treatment of calcaneal fractures make important sense.The clinical classification of intra-articular calcaneal fractures has more than20series.The first classification was introduced by Essex—Lopresti in1952, he base on the lateral X-ray observe the change of Bohler angle and Gissane angle and calcaneal double density, they according to whether the fracture spread to subtalar articular surface of the calcaneus fracture, roughly divided the calcaneus fracture into intra-articular fractures and extra-articular fractures.However, X-ray classification has great limitations, along with the development of CT scanning,Sander based on the posterior articular bone fracture blocks in the CT coronal and axial performance to make an accurate assessment, a very good classification scheme for the treatment of calcaneal fractures was proposed, and was widely recognized by scholars.On the treatment of intra-articular calcaneal fracture, has been controversial in the past160years,At present, treatment of calcaneal fractures include operation and non operation.Method of non operation therapy:manual reduction, plaster, traction, compression bandage, elastic bandage, physiotherapy and so on.Operation treatment methods commonly include:open reduction and internal fixation, needle percutaneous poking reduction, external fixation, arthrodesis.In recent years, with the development of improved surgical techniques and orthopedics equipment, more and more doctors and patients choose operative to cure the displaced intra-articular calcaneal fracture,However, the final outcome of calcaneal fracture operation is still controversial, on the other hand, we found through the study of literature that,Whether the operation or conservative treatment, have successful case report.In order to find the best treatment of calcaneal fracture, this paper referred to the database, select the highest level of evidence from randomized controlled trials (RCT) literature,exclude q-RCT,Meta-analysis on efficacy of operation and conservative treatment of displaced intra-articular calcaneal fractures, we hoping to find out the best treatment methods to help clinical treatment through this article.ObjectiveTo compare clinical efficacy of operative with nonoperative treatment for displaced intra-articular calcaneal fracture.MethodsAccording to the standards of the Cochrane Collaboration, all of randomized controlled trials(RCTs)comparing operative with nonoperative treatment of DIACF were searched in PubMed,Embase,CENTAL,CBM et al. Effective data were pooled for Meta analysis.ResultsSix articles with a total of627patients were recruited in our study. Results showed that the number of patients in operative group was smaller than the nonoperative group in increased shoe sizes (RR=0.42,95%CI (0.26～0.68), P=0.0004), failing to resume pre-injury work (RR=0.46,95%CI (0.27～0.81), P=0.006) and associated with a higher risk of complications (RR=1.47,95%CI (1.06～2.04), P=0.02). However, no significant differences were observed in terms of Bohler angle improvement (MD=6.5,95%CI (-0.34-13.34),P=0.06), stabler height (MD=1.0,95%CI (-2.47～4.47), P=0.57), the limitation of walking distance (RR=0.88,95%CI (0.57-1.36), P=0.56), residual pains (RR=0.73,95%CI (0.40～1.36), P=0.33)ConclusionOperative treatment can bring better restoration of the calcaneal structure and lead to better socially functional recovery to some degree. Take all factors into consideration, operation is probably the optimal choice of DIACF treatment.