Meta-analysis Of The Effectiveness Of Bone Grafting And Non-Bone Grafting For Displaced Intra-articular Calcaneal Fracture: A Systematic Review

Objective:The paper provides a systematical review of treatment of calcaneal fractures by bone grafting and non-bone grafting for displacement of intra-articular calcaneal fractures in the randomized controlled trials(RCTs), with the method of Meta-Analysis recommended by Cochrane. Comparisons of treatment effectiveness by bone grafting and non-bone grafting are made, in order to provide theoretical evidences for the research of clinical treatment methods of calcaneal fractures.Methods:Randomized controlled trials(RCTs) and case-control study of bone grafting and no bone grafting for displaced intra-articular calcaneal fractures were searched in following databases, including Pub Med(1954~2015.3), EMbase(1954~2015.3), The Cochrane Library, CNKI(1979 ~ 2015.3), VIP(1989 ~ 2015.3), CBM(1954 ~ 2015.3) and Wan Fang Data(1998 ~ 2015.3). Two reviewers independently screened the literature according to the criteria of inclusion and exclusion. Data are used and data quality is assessed, and the meta-analysis was performed with software Rev Man 5.2.Results:Total 16 literatures and 16 clinical researches including 1299 patients, of whom 769 are treated by bone grafting and 530 by no bone grafting, were included in the study.Results of the Meta analysis demonstrate that, the bone grafting group is superior to the no bone grafting group, with foot function at [OR=2.12, 95%CI(1.57, 2.86), P<0.00001]and B?hler’s angle loss at [MD=-2.66, 95%CI(-3.04,-2.27), P<0.00001]. There is no significant difference between results of bone grafting group and the no bone grafting group, with Gissane’s angle loss at [SMD=-0.39, 95%CI(-1.39, 0.61), P=0.45] and reduction of calcaneal height at [MD=-0.53, 95CI(-2.19, 1.14), P=0.54].Conclusions:Clinical treatment of displaced intra-articular calcaneal fractures patients by bone grafting improves the foot function rate of patients after surgery and their life quality.Due to the limited quantity and quality of included data, higher quality and larger sample RCTs are expected to be performed in the future for a more solid conclusion.