A Meta-analysis Of Classic Treatment For DIACF And The Clinical Outcome Of Using The New Calcaneal External Fixator

Purpose:(1) To evaluate the advantages and disadvantages of the classical treatment strategy for intra-articular calcaneal fractures by Meta analysis.(2) To investigate the clinical outcome of the treatment of calcaneal fracture with mini external fixator.Methods:(1) We systematically searched the Cochrane Library,EMbase and Pub Med databases for relevant RCTs compared the operative and non-operative treatment of DIACFs published in any language from the earliest available records to 24 May 2015. The main outcomes were some incidences of complications,re-operations and other patient-centered functional outcomes(2) Under the guidance of the C-arm fluoroscopic,reconstruct the calcaneal fractures and fixed by the mini external fixator. The average fixation time was 3 months,and the preoperative Bohler angle was compared with the postoperative one. Using the Iowa calcaneal scoring system to evaluate the prognosis of the fracture.Result:(1) The Meta-analysis included a total of 804 patients from six RCTs. No significant differences were found between the operative and the nonoperative groups in the incidence of complications(P=0.259),re-operations(P=0.815),AOFAS with short-term followed-up( P=0.258), AOFAS with long-term followed-up(P=0.919),SF-36 mental(P=0.863),residual pain(P=0.221),failure to return to work(P=0.398). Fewer patients had problems with wearing shoes(P=0.043),with a lower subtalar arthritis risk(P=0.000) and a higher SF-36 physical score(P=0.003) in the operative groups.(2) Since 2013 to 2015 29 patients,a total of 31 cases of calcaneal fractures treated with micro external fixator fixation. 15 cases treated with closed reduction and 16 cases of open reduction and external fixation. All of the 29 patients(including two patients with bilateral calcaneal fractures) were followed up for average 16.5 months. The Iowa score of 16 cases(51.6%) were excellent,11 cases(35.5%) were good,2 cases(6.5%) qualified,failure in 1 cases,and 1 cases were lost. 31 cases of calcaneal fractures with an average preoperative Bohler angle of 12.1 degrees(3 degrees-20 degrees),and the average postoperative Bohler angle was 29.8 degrees(20 degrees-37 degrees),the t test show the P=0.000.Conclusion:(1) Operative treatments outperformed nonoperative treatments in the subtalar arthritis rate,having a SF-36 mental score and with shoe wearing problems. Therefore,we still recommend an operative treatment for DIACFs,but we should reduce the infection rate of operative site.(2) Miniature external fixator combined with open or closed reduction is an ideal treatment plan for various types of calcaneal fractures. The micro external fixator of the 8 needle system is reliable and allowing patients to carry out early joint functional exercise to reduce the loss of reduction and the probability of joint stiffness.