Cannulated screw vs plate fixation for displaced intra-articular calcaneus fracture

Study Type: Meta analysis
OE Level of Evidence: 1
Journal Level of Evidence: N/A
Five randomized controlled trials were included in this meta-analysis comparing cannulated screw fixation and plate fixation of displaced intra-articular calcaneal fractures. Clinical outcomes, radiographic outcomes, operative time, and complication rates were compared. Results demonstrated no Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: National Natural Science Foundation of China; Ministry of Science and Technology, China; Tianjin Science and Technology Committee
Conflicts: None disclosed
Why was this study needed now?
Displaced intra-articular calcaneus fractures are common and are often caused by a fall from height. Open reduction and internal fixation using a plate have become the gold standard for the treatment of these fractures. However, a number of studies have demonstrated that fixation using a cannulated screw through either a minimally invasive or percutaneous method may provide similar outcomes while reducing operative time and wound complications. A synthesis of available high-quality evidence was needed to determine if there are differences between these two methods of fixation for these fractures.
What was the principal research question?
Is there any significant difference in clinical or radiographic outcome in the treatment of a displaced intra-articular calcaneus fracture between cannulated screw fixation and plate fixation?
Data Source: PubMed, EMBASE, the Cochrane Library, and the China National Knowledge Infrastructure were searched for relevant articles published up to March 2016.
Index Terms: Search terms included appropriate search derivatives of "calcaneal fracture", "calcaneus fracture", "cannulated screw", "cannulated cancellous screw", "plate", and "calcaneal plate".
Study Selection: Eligibility criteria included: a randomized controlled trial design; enrolled adult patients with a displaced intra-articular calcaneal fracture; allocated patients to treatment with either cannulated screw fixation or plate fixation; and reported one of the following outcomes: calcaneal width, Bohler's angle, Gissane's angle, the American Orthopaedic Foot and Ankle Society score, operative time, and complication rate. The selection was performed independently by two reviewers, with disagreement resolved through discussion with a third reviewer. A total of five randomized controlled trials, with data sampled from 707 patients, were selected for final inclusion.
Data Extraction: Data extraction was performed independently by two reviewers, with disagreement resolved by discussion and consensus.
Data Synthesis: Statistical analyses were performed using Review Manager software (RevMan 5.3). Standardized mean differences were calculated for continuous outcomes, and odds ratios for dichotomous outcomes, both with associated 95% confidence intervals.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.