Open Reduction And Internal Fixation Versus Nonoperative Treatment For Displaced Intra-articular Calcaneal Fractures: A Meta-analysis

Objective: To compare the effect of open reduction and internal fixation with nonoperative treatment for displaced intra-articular calcaneal fractures by Meta-analysis.Methods: Randomized controlled trials(RCTs) comparing the effect of open reduction and internal fixation with nonoperative treatment for displaced intra-articular calcaneal fractures were searched from Pubmed, Cochrane Library, EMBASE, Chinese Biomedical Database(CBM), China National Knowledge Infrastructure(CNKI), Wanfang Database. Screen out the qualified studies according to the inclusion and exclusion criteria. Assess the quality of all selected studies and extract the data from them. The outcome measures of the research included impact to wear shoes, residual pain, subtalar arthrodesis, complications, visual analog scale(VAS) score, ankle function score, Bohler angle and return to work. Meta-analysis was performed by the RevMan5.3 statistical software provided by Cochrane Collaboration. Use Relative Risk(RR) to count dichotomous data and Weighted Mean Difference(WMD) to count continuous variables. Both of them were given 95% confidence interval(CI). Heterogeneity was analyzed with both the Chi square test and the I2 test. P<0.1 for the Chi square test was interpreted as evidence of statistical heterogeneity. I2 was used to estimate total variation across the studies. If I2<50%, the fixed-effect model was applied;and if I2≥50%, the random-effect model was applied. The qualitative assessment would be carried out by describing if the quantitative synthesis couldn’t be performed.Results: According to the inclusion and exclusion criteria, five RCTs with a total of 738 patients were included. All of the five studies were in high methodology quality. The Meta-analysis results showed that there were no statistically significant differences in impact to wear shoes, residual pain, VAS score between open reduction and internal fixation and nonoperative groups. Open reduction and internal fixation group had a lower rate of subtalar arthrodesis but a higher rate of complications compared with nonoperative group. The descriptive analysis results showed that open reduction and internal fixation group was better than nonoperative group in improving the function of ankle and Bohler angle.Conclusion: As for displaced intra-articular calcaneal fractures, appropriate treatment should be selected according to different fractures. The best patients to treat by open reduction and internal fixation are young, simple displaced fracture and good soft tissue condition. Nonoperative treatment is suitable for patients who are old, severely comminuted fracture and poor soft tissue condition.