Minimally invasive versus extensile lateral approach for sanders type II and III calcaneal fractures: A meta-analysis of randomized controlled trials.

BACKGROUND

The use of less-invasive techniques in the treatment of displaced intra-articular calcaneal fractures (DIACFs) remains controversial. No prior meta-analysis has considered the influence of differences in the fracture type. Thus, our meta-analysis aimed to investigate the efficacy and safety of minimally invasive (MI) in Sanders type II and III fractures.

MATERIALS AND METHODS

A comprehensive search was performed to identify RCTs comparing MI using sinus tarsi approach (STA) or percutaneous reduction (PR) to open reduction (OR) via extensile lateral approach (ELA) from the Cochrane Library, PubMed, Embase and CNKI. Dichotomous and continuous data were pooled using risk ratio (RR) and mean difference (MD), respectively, with 95% confidence intervals (CIs). The data were analysed using Review Manager 5.3.

RESULTS

Eight RCTs (495 participants) were selected in our meta-analysis. Based on the American Orthopaedic Foot and Ankle Society score (AOFAS), both general pooled data and subgroup analysis of Sanders type II fractures indicated that MI improves functional outcomes, while in the Sanders type III subgroup, the advantage disappeared. Additionally, the pooled results showed that MI reduces the rate of wound complications; lowers the VAS score; and shortens the time to surgery, duration of surgery and length of hospital stay. There was no statistical significance with respect to recovery of calcaneus length and width or improvement of Gissane's angle and Bohler's angle.

CONCLUSION

Our meta-analysis suggests that MI and ELA are equally effective treating Sanders type II and III fractures. However, MI is effective in improving the AOFAS score (Sanders type II); reducing the rate of wound complications; and shortening the time to surgery, duration of surgery and length of hospital stay.