Abstract
The aim of our meta-analysis was to compare outcomes for two surgical treatments of calcaneal fractures, percutaneous reduction and fixation with Kirschner wires (PRFK) and open reduction internal fixation (ORIF), with the intent of evaluating the quality of evidence to inform practice. Search of MEDLINE, Cochrane and CNKI databases to identify randomized controlled trials (RCTs) comparing PRKF and ORIF on the following outcomes: post-operative function, complications and quality of the reduction. Odd ratios (OR) and weighted mean differences were pooled using either a fixed-effects or random-effects model, depending on the heterogeneity of the trials included in the analysis. Eighteen RCTs provided the data from 1407 patients. PRFK was associated with a lower risk of surgical wound complications, and ORIF with better post-operative function, angle of Gissane, calcaneal height, and calcaneal width. There were no statistically significant differences between the techniques with regards to post-operative Böhler’s angle. PRFK does not provide a substantive advantage over ORIF for the treatment of calcaneal fractures in adults. PRFK may, however, yield comparable functional outcomes to ORIF for closed Sanders type II calcaneal fractures but with less complication related to surgical wound healing.
Highlights
Knowledge and expertise in managing closed fractures of the calcaneus in adults has significantly increased over the past few years
No information of method of blinding was included in the trials, we assumed that participants, research personnel and outcome assessors had full knowledge of the surgical technique used and, of group assignment
Calcaneal fractures are frequent fractures managed in orthopedic clinics
Summary
Knowledge and expertise in managing closed fractures of the calcaneus in adults has significantly increased over the past few years. Conservative management methods have been popular[1], consisting of reducing the width of the calcaneus with use of a hammer, taking care to limit soft tissue trauma, followed by plantarflexion of the forefoot to restore the plantar arch. The popularity of using percutaneous reduction and fixation with Kirschner wires (PRFK) as a minimally invasive treatment for calcaneal fractures has increased in China. This procedure usually consists of inserting a Kirschner wires (K-wire), using a joystick, from the calcaneal tuberosity to beneath the subtalar joint, with plantarflexion of the forefoot used to reduce the fracture. We conducted a literature search to identify randomized controlled trials (RCTs) comparing PRFK and ORIF techniques and performed a meta-analysis with the intent of evaluating the evidence to inform selection of the preferred technique
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