Attenasio Andrea, Heiman Erick, Hong Ian S, Bhalla Aditya Paul, Jankowski Jaclyn M, Yoon Richard S, Liporace Frank A, Dziadosz Daniel
Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA.
Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA.
Injury. 2024 Jun;55(6):111560. doi: 10.1016/j.injury.2024.111560. Epub 2024 Apr 16.
To analyze recent literature comparing clinical outcomes of displaced intra-articular calcaneal fractures (DIACF) treated with open reduction and internal fixation using the extensile lateral approach (ELA) vs the minimally invasive sinus tarsi approach (STA), with a focus on wound complications.
A comprehensive literature search was conducted utilizing PubMed, EMBASE, and Cochrane Library databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 2013 and 2022, level of evidence (LOE) I-III, head-to-head comparative studies reporting on clinical outcomes after DIACFs treated with ORIF using ELA versus STA, and literature with full-text written in English were included. Data collection included: publication year, study design, number of surgeons, number of participants, demographic data (mean age at time of surgery, percent male, body mass index, medical co-morbidities), preoperative data (mechanism of injury, Sanders classification, time from injury to surgical fixation), intraoperative data, and postoperative clinical and radiographic outcomes (Böhler angle, angle of Gissane, calcaneal height/length/width).
A total of 21 articles (4 randomized control trials, 17 cohort studies) comprising of 2086 patients with calcaneal fractures, treated with either ELA (n = 1129) or STA (n = 957) met inclusion criteria. The risk of postoperative wound-related complications (RR 2.82, 95 % CI: 2.00-3.98, I=27 %) and the risk of reoperation (RR 1.85, 95 % CI: 0.69-5.00, I2=67 %) was higher in ELA patients comparted to STA patients. However, the increased risk of postoperative wound-related complications with an ELA vs. STA was shown to be trending downward in recent publications. The ELA group also experienced longer time to surgery, extended operative times, and prolonged hospital stays when compared to the STA group. Radiographic measurements at final follow-up, including Böhler angle, angle of Gissane, as well as calcaneal height, length, and width, showed no statistically significant differences between the two groups.
Surgical treatment of calcaneal fractures utilizing the ELA continues to have an increased rate of complications and reoperation when compared to the less invasive STA, yet recent trends in the literature show that this rate is decreasing. Operative treatment of calcaneal fractures via either an ELA or STA can both achieve comparable postoperative radiographic outcomes.
Therapeutic Level III.
分析近期比较采用扩大外侧入路（ELA）与微创跗骨窦入路（STA）切开复位内固定治疗移位性关节内跟骨骨折（DIACF）临床结果的文献，重点关注伤口并发症。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，利用PubMed、EMBASE和Cochrane图书馆数据库进行全面的文献检索。纳入2013年至2022年发表的研究，证据级别（LOE）为I - III级，关于采用ELA与STA切开复位内固定治疗DIACF后临床结果的直接比较研究，以及全文为英文的文献。数据收集包括：发表年份、研究设计、外科医生数量、参与者数量、人口统计学数据（手术时的平均年龄、男性百分比、体重指数、合并症）、术前数据（损伤机制、Sanders分类、受伤至手术固定的时间）、术中数据以及术后临床和影像学结果（Böhler角、Gissane角、跟骨高度/长度/宽度）。
共有21篇文章（4项随机对照试验，17项队列研究），包含2086例跟骨骨折患者，分别采用ELA（n = 1129）或STA（n = 957）治疗，符合纳入标准。与STA组患者相比，ELA组患者术后伤口相关并发症风险（RR 2.82，95% CI：2.00 - 3.98，I² = 27%）和再次手术风险（RR 1.85，95% CI：0.69 - 5.00，I² = 67%）更高。然而，在近期发表的文献中，ELA与STA相比术后伤口相关并发症风险增加的趋势呈下降趋势。与STA组相比，ELA组手术时间更长、手术时长延长且住院时间延长。末次随访时的影像学测量，包括Böhler角、Gissane角以及跟骨高度、长度和宽度，两组之间无统计学显著差异。
与侵入性较小的STA相比，采用ELA治疗跟骨骨折的并发症和再次手术率仍然较高，但近期文献趋势表明该比率正在下降。通过ELA或STA手术治疗跟骨骨折均可获得相当的术后影像学结果。
治疗性III级。
