Department of Orthopaedics, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.
Department of Orthopaedics, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal.
Foot Ankle Surg. 2022 Apr;28(3):281-287. doi: 10.1016/j.fas.2021.04.006. Epub 2021 Apr 18.
Displaced intra-articular calcaneus fractures (DIACF) Sanders type IV represent a challenge in its management and questions remain about the best treatment option available. This study aimed to compare the outcomes of primary subtalar arthrodesis (PSTA) and osteosynthesis in these fractures.
Studies concerning DIACF Sanders type IV, from 2005 to 2020 were systematically reviewed. Only studies evaluating functional outcomes with American Orthopaedic Foot & Ankle Society ankle-hindfoot (AOFAS) score were admitted allowing for results comparison.
In total, 9 studies met the inclusion criteria. These reported on the results of 142 patients, from which 41 submitted to PSTA and 101 to osteosynthesis, with an average follow-up period over 2 years. We found a significant moderate negative correlation between the reported AOFAS score and the Coleman Methodology Score obtained. Late subtalar arthrodesis was 13.63% of the total osteosynthesis performed.
Clinical outcomes after PSTA and osteosynthesis, for the treatment of Sanders type IV fractures, do not seem very different, yet careful data interpretation is crucial. Additional powered randomized controlled trials are necessary to assess which surgical strategy is better.
关节内跟骨移位骨折（DIACF）Sanders 型 IV 代表了其治疗的挑战，对于最佳治疗方案仍存在疑问。本研究旨在比较这些骨折中初次跗骨关节融合术（PSTA）和内固定术的治疗效果。
系统回顾了 2005 年至 2020 年期间有关 DIACF Sanders 型 IV 的研究。仅纳入评估美国矫形足踝协会踝后足（AOFAS）评分功能结果的研究，以允许结果比较。
共有 9 项研究符合纳入标准。这些研究报告了 142 例患者的结果，其中 41 例接受了 PSTA，101 例接受了内固定术，平均随访时间超过 2 年。我们发现报告的 AOFAS 评分与获得的 Coleman 方法评分之间存在显著的中度负相关。晚期距下关节融合术占所有内固定术的 13.63%。
对于 Sanders 型 IV 骨折的治疗，PSTA 和内固定术的临床结果似乎没有太大差异，但仔细解释数据至关重要。需要更多的随机对照试验来评估哪种手术策略更好。
