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Archives of Orthopaedic and Trauma Surgery

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25.08.2023 | Orthopaedic Surgery

Comparison between screw fixation and plate fixation via sinus tarsi approach for displaced intra-articular calcaneal fractures: a systematic review and meta-analysis

verfasst von: Binzhi Zhao, Xiaopei Xu, Qingnan Sun, Yang Liu, Yanrui Zhao, Dong Wang, Yulin Gao, Junlin Zhou

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 1/2024

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Abstract

Background

Optimal surgical fixation for displaced intra-articular calcaneal fractures (DIACF) remains a subject of debate, particularly regarding the superiority between screw fixation and plate fixation via the sinus tarsi approach (STA). This review aims to determine the preferred treatment for DIACF and compare the outcomes of minimally invasive surgery options.

Methods

Our study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on distal intra-articular fractures of the calcaneus (DIACFs) that were fixed using cannulated screws or plates via STA. Through a comprehensive meta-analysis, we evaluated several outcomes, including post-operative function, radiological measurements, and complications.

Result

A total of 728 patients from 7 studies met the inclusion criteria. Among them, 435 patients underwent screw fixation via STA, and 373 patients underwent plate fixation via STA. The study found no statistically significant differences between the screw fixation and the plate fixation via sinus tarsi approach (STA) in terms of AOFAS scores, Bohler’s angle, Gissane’s angle, sural nerve injury, secondary subtalar arthrodesis and reoperation. Compared with screw fixation, plate fixation via STA can reduce reduction loss of Bohler’s angle (WMD = − 1.64, 95% CI = [− 2.96, − 0.31], P = 0.06, I² = 59%), lower the incidence of fixation failure (OR = 0.32, 95% CI = [0.13, 0.81], P = 0.78, I² = 0%), and decrease intra-articular step-off (WMD = − 0.52, 95% CI = [− 0.87, − 0.17], P = 0.66, I² = 0%).

Conclusions

Plate fixation demonstrates superior capability in restoring calcaneal width, maintaining Bohler’s angle, and minimizing intra-articular step-off, thereby maintaining better reduction of the subtalar articular surface. In addition, plate fixation exhibits the modest complication rate and a low incidence of fixation failure. Therefore, we recommend the use of plate fixation through the STA, especially for complex and comminuted intra-articular calcaneal fractures.

Ågren P-H, Wretenberg P, Sayed-Noor AS (2013) Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures. J Bone Jt Surg-Am 95:1351–1357. https://doi.org/10.2106/JBJS.L.00759CrossRef

Potter MQ, Nunley JA (2009) Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus. J Bone Jt Surg-Am 91:1854–1860. https://doi.org/10.2106/JBJS.H.01475CrossRef

Tomesen T, Biert J, Frölke JM (2011) Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Jt Surg-Am 93:920–928. https://doi.org/10.2106/JBJS.H.01834CrossRef

Banerjee R, Saltzman C, Anderson RB, Nickisch F (2011) Management of calcaneal malunion. Am Acad Orthop Surg 19:27–36. https://doi.org/10.5435/00124635-201101000-00004CrossRef

Clare MP, Lee WE, Sanders RW (2005) Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions. J Bone Jt Surg 87:963–973. https://doi.org/10.2106/JBJS.C.01603CrossRef

Radnay CS, Clare MP, Sanders RW (2009) Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? J Bone Jt Surg-Am 91:541–546. https://doi.org/10.2106/JBJS.G.01445CrossRef

Buckley R, Tough S, McCormack R et al (2002) Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures. J Bone Jt Surg-Am 84:1733–1744. https://doi.org/10.2106/00004623-200210000-00001CrossRef

De Boer AS, Van Lieshout EMM, Den Hartog D et al (2015) Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment. J Foot Ankle Surg 54:298–305. https://doi.org/10.1053/j.jfas.2014.04.014CrossRefPubMed

Sanders R (2000) Displaced intra-articular fractures of the calcaneus*. J Bone Jt Surg-Am Vol 82:225–250. https://doi.org/10.2106/00004623-200002000-00009CrossRef

10.

Al-Mudhaffar M, Prasad CVR, Mofidi A (2000) Wound complications following operative fixation of calcaneal fractures. Injury 31:461–464. https://doi.org/10.1016/s0020-1383(00)00026-7CrossRefPubMed

11.

Stulik J, Stehlik J, Rysavy M, Wozniak A (2006) Minimally-invasive treatment of intra-articular fractures of the calcaneum. J Bone Jt Surg Br 88-B:1634–1641. https://doi.org/10.1302/0301-620X.88B12.17379CrossRef

12.

Rammelt S, Heineck J, Barthel S, Zwipp H (2009) Percutaneous fixation of intraarticular calcaneus fractures. Tech Foot Ankle Surg 8:70–76. https://doi.org/10.1097/BTF.0b013e3181a77f71CrossRef

13.

Schuberth JM, Cobb MD, Talarico RH (2009) Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J Foot Ankle Surg 48:315–322. https://doi.org/10.1053/j.jfas.2009.01.002CrossRefPubMed

14.

Zhang T, Su Y, Chen W et al (2014) Displaced intra-articular calcaneal fractures treated in a minimally invasive fashion: longitudinal approach versus sinus tarsi approach. J Bone Jt Surg Am 96:302–309. https://doi.org/10.2106/JBJS.L.01215CrossRef

15.

Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1. https://doi.org/10.1186/2046-4053-4-1CrossRefPubMedPubMedCentral

16.

Schiavo JH (2019) PROSPERO: an international register of systematic review protocols. Med Ref Serv Q 38:171–180. https://doi.org/10.1080/02763869.2019.1588072CrossRef

17.

Higgins JPT, Altman DG, Gotzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928–d5928. https://doi.org/10.1136/bmj.d5928CrossRefPubMedPubMedCentral

18.

Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605. https://doi.org/10.1007/s10654-010-9491-zCrossRefPubMed

19.

Singotani RG, Karapinar F, Brouwers C et al (2019) Correction to: towards a patient journey perspective on causes of unplanned readmissions using a classification framework: results of a systematic review with narrative synthesis. BMC Med Res Methodol 19:214. https://doi.org/10.1186/s12874-019-0851-4CrossRefPubMedPubMedCentral

20.

Eelsing R, Aronius LB, Halm JA, Schepers T (2023) Implant choice and outcomes of the sinus tarsi approach for displaced intra-articular calcaneal fractures. Foot Ankle Int. https://doi.org/10.1177/10711007231176276CrossRefPubMedPubMedCentral

21.

Sato K, Yorimitsu M, Uehara T et al (2023) Comparison of screw versus locking plate fixation via sinus tarsi approach for displaced intra-articular calcaneal fractures. Foot Ankle Surg 29:97–102. https://doi.org/10.1016/j.fas.2022.11.002CrossRefPubMed

22.

Usami T, Takada N, Nishida K et al (2023) Fixation of intra-articular calcaneal fractures: a comparative study of the postoperative outcome between HA/PPLA screws and locking plates. Heliyon 9:e14046. https://doi.org/10.1016/j.heliyon.2023.e14046CrossRefPubMedPubMedCentral

23.

Guo C, Xu Y, Li C et al (2021) Comparing less invasive plate fixation versus screw fixation of displaced intra-articular calcaneus fracture via sinus tarsi approach. Int Orthop 45:2231–2237. https://doi.org/10.1007/s00264-020-04867-5CrossRefPubMed

24.

Chotikkakamthorn N, Chanajit A, Tharmviboonsri T et al (2021) Minimal invasive surgery in the management of intra-articular calcaneal fractures: a retrospective comparison of screw fixation alone versus screw with small locking plate fixation techniques. Acta Orthop Traumatol Turc 55:258–264. https://doi.org/10.5152/j.aott.2021.20003CrossRefPubMedPubMedCentral

25.

Pitts CC, Almaguer A, Wilson JT et al (2019) Radiographic and postoperative outcomes of plate versus screw constructs in open reduction and internal fixation of calcaneus fractures via the sinus tarsi. Foot Amp Ankle Int 40:929–935. https://doi.org/10.1177/1071100719848063CrossRef

26.

Kir MC, Ayanoglu S, Cabuk H et al (2018) Mini-plate fixation via sinus tarsi approach is superior to cannulated screw in intra-articular calcaneal fractures: a prospective randomized study. J Orthop Surg 26:230949901879274. https://doi.org/10.1177/2309499018792742CrossRef

27.

Kline AJ, Anderson RB, Davis WH et al (2013) Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Amp Ankle Int 34:773–780. https://doi.org/10.1177/1071100713477607CrossRef

28.

Abdelazeem A, Khedr A, Abousayed M et al (2014) Management of displaced intra-articular calcaneal fractures using the limited open sinus tarsi approach and fixation by screws only technique. Int Orthop 38:601–606. https://doi.org/10.1007/s00264-013-2203-zCrossRefPubMed

29.

Ni M, Wong DW-C, Mei J et al (2016) Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures. Sci China Life Sci 59:958–964. https://doi.org/10.1007/s11427-016-0010-9CrossRefPubMed

30.

Rammelt S, Amlang M, Barthel S et al (2010) Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Amp Relat Res 468:983–990. https://doi.org/10.1007/s11999-009-0964-xCrossRef

31.

Smerek JP, Kadakia A, Belkoff SM et al (2008) Percutaneous screw configuration versus perimeter plating of calcaneus fractures: a cadaver study. Foot Amp Ankle Int 29:931–935. https://doi.org/10.3113/FAI.2008.0931CrossRef

32.

Nelson JD, McIff TE, Moodie PG et al (2010) Biomechanical stability of intramedullary technique for fixation of joint depressed calcaneus fracture. Foot Amp Ankle Int 31:229–235. https://doi.org/10.3113/FAI.2010.0229CrossRef

33.

Rausch S, Klos K, Wolf U et al (2014) A biomechanical comparison of fixed angle locking compression plate osteosynthesis and cement augmented screw osteosynthesis in the management of intra articular calcaneal fractures. Int Orthop 38:1705–1710. https://doi.org/10.1007/s00264-014-2334-xCrossRefPubMedCentral

34.

Rammelt S, Sangeorzan BJ, Swords MP (2018) Calcaneal fractures—should we or should we not operate? Indian J Orthop 52:220–230. https://doi.org/10.4103/ortho.IJOrtho_555_17CrossRefPubMedCentral

35.

Persson J, Peters S, Haddadin S et al (2015) The prognostic value of radiologic parameters for long-term outcome assessment after an isolated unilateral calcaneus fracture. Technol Health Care 23:285–298. https://doi.org/10.3233/THC-140890CrossRefPubMed

36.

Fan B, Zhou X, Wei Z et al (2016) Cannulated screw fixation and plate fixation for displaced intra-articular calcaneus fracture: a meta-analysis of randomized controlled trials. Int J Surg 34:64–72. https://doi.org/10.1016/j.ijsu.2016.08.234CrossRefPubMed

37.

DeWall M, Henderson CE, McKinley TO et al (2010) Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures. J Orthop Trauma 24:466–472. https://doi.org/10.1097/BOT.0b013e3181defd74CrossRefPubMed

38.

Schepers T, van Lieshout EMM, van Ginhoven TM et al (2008) Current concepts in the treatment of intra-articular calcaneal fractures: results of a nationwide survey. Int Orthop 32:711–715. https://doi.org/10.1007/s00264-007-0385-yCrossRefPubMed

39.

Chen W, Li X, Su Y et al (2011) Peroneal tenography to evaluate lateral hindfoot pain after calcaneal fracture. Foot Ankle Int 32:789–795. https://doi.org/10.3113/FAI.2011.0789CrossRefPubMed

40.

Wang Q, Chen W, Su Y et al (2010) Minimally invasive treatment of calcaneal fracture by percutaneous leverage, anatomical plate, and compression bolts–the clinical evaluation of cohort of 156 patients. J Trauma 69:1515–1522. https://doi.org/10.1097/TA.0b013e3181e16150CrossRefPubMed

41.

Makki D, Alnajjar HM, Walkay S et al (2010) Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. J Bone Jt Surg Br 92:693–700. https://doi.org/10.1302/0301-620X.92B5.23542CrossRef

42.

Gavlik JM, Rammelt S, Zwipp H (2002) Percutaneous, arthroscopically-assisted osteosynthesis of calcaneus fractures. Arch Orthop Trauma Surg 122:424–428. https://doi.org/10.1007/s00402-002-0397-4CrossRefPubMed

43.

Kurozumi T, Jinno Y, Sato T et al (2003) Open reduction for intra-articular calcaneal fractures: evaluation using computed tomography. Foot Ankle Int 24:942–948. https://doi.org/10.1177/107110070302401214CrossRefPubMed

44.

Scott AT, Pacholke DA, Hamid KS (2016) Radiographic and CT assessment of reduction of calcaneus fractures using a limited sinus tarsi incision. Foot Ankle Int 37:950–957. https://doi.org/10.1177/1071100716650538CrossRefPubMed

45.

Weber M, Lehmann O, Sägesser D, Krause F (2008) Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. J Bone Jt Surg Br 90-B:1608–1616. https://doi.org/10.1302/0301-620X.90B12.20638CrossRef

46.

Ceccarini P, Manfreda F, Petruccelli R et al (2021) Minimally invasive sinus tarsi approach in Sanders II-III calcaneal fractures in high-demand patients. Med Glas Ljek Komore Zenicko-Doboj Kantona 18:322–327. https://doi.org/10.17392/1282-21CrossRef

47.

Xia S, Wang X, Lu Y et al (2013) A minimally invasive sinus tarsi approach with percutaneous plate and screw fixation for intra-articular calcaneal fractures. Int J Surg 11:1087–1091. https://doi.org/10.1016/j.ijsu.2013.09.017CrossRefPubMed

48.

Spagnolo R, Bonalumi M, Pace F, Capitani D (2010) Calcaneus fractures, results of the sinus tarsi approach: 4 years of experience. Eur J Orthop Surg Traumatol 20:37–42. https://doi.org/10.1007/s00590-009-0482-2CrossRef

49.

Li S (2018) Wound and sural nerve complications of the sinus tarsi approach for calcaneus fractures. Foot Ankle Int 39:1106–1112. https://doi.org/10.1177/1071100718774808CrossRefPubMed

Titel: Comparison between screw fixation and plate fixation via sinus tarsi approach for displaced intra-articular calcaneal fractures: a systematic review and meta-analysis
verfasst von: Binzhi Zhao
Xiaopei Xu
Qingnan Sun
Yang Liu
Yanrui Zhao
Dong Wang
Yulin Gao
Junlin Zhou
Publikationsdatum: 25.08.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 1/2024
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05041-3

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Comparison between screw fixation and plate fixation via sinus tarsi approach for displaced intra-articular calcaneal fractures: a systematic review and meta-analysis

Abstract

Background

Methods

Result

Conclusions

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Result

Conclusions

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