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.
RESULTS: 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.
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.
RESULTS: 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.
摘要：
背景：移位的跟骨关节内骨折（DIACF）的最佳手术固定仍是一个争论的话题，特别是关于螺钉固定和钢板固定之间的优势通过关节窦入路（STA）。这篇综述旨在确定DIACF的首选治疗方法，并比较微创手术选择的结果。
方法：我们的研究涉及跨多个电子数据库的彻底搜索，包括PubMed,科克伦,Embase,和WebofScience,确定所有与跟骨远端关节内骨折（DIACFs）相关的出版物，这些跟骨远端骨折使用空心螺钉或钢板通过STA固定。通过全面的荟萃分析，我们评估了几个结果，包括术后功能，放射学测量，和并发症。
结果：7项研究共728名患者符合纳入标准。其中,435例患者通过STA进行螺钉固定，373例患者通过STA进行钢板固定。该研究发现，螺钉固定和通过骨窦入路（STA）的钢板固定在AOFAS评分方面没有统计学上的显着差异。博勒的角度,Gissane\的角度,腓肠神经损伤,二次距下关节固定术和再手术。与螺钉固定相比，通过STA固定钢板可以减少博勒角度的减少损失(WMD=-1.64，95%CI=[-2.96，-0.31]，P=0.06,I2=59%),降低固定失败的发生率(OR=0.32，95%CI=[0.13，0.81]，P=0.78，I2=0%），并减少关节内台阶（WMD=-0.52，95%CI=[-0.87，-0.17]，P=0.66，I2=0%）。
结论：钢板内固定显示出优越的恢复跟骨宽度的能力，保持博勒的角度,尽量减少关节内台阶，从而保持距下关节面更好的复位。此外,钢板内固定的并发症发生率适中，固定失败的发生率较低。因此,我们建议通过STA使用钢板固定，特别是复杂和粉碎性跟骨关节内骨折。
方法：我们的研究涉及跨多个电子数据库的彻底搜索，包括PubMed,科克伦,Embase,和WebofScience,确定所有与跟骨远端关节内骨折（DIACFs）相关的出版物，这些跟骨远端骨折使用空心螺钉或钢板通过STA固定。通过全面的荟萃分析，我们评估了几个结果，包括术后功能，放射学测量，和并发症。
结果：7项研究共728名患者符合纳入标准。其中,435例患者通过STA进行螺钉固定，373例患者通过STA进行钢板固定。该研究发现，螺钉固定和通过骨窦入路（STA）的钢板固定在AOFAS评分方面没有统计学上的显着差异。博勒的角度,Gissane\的角度,腓肠神经损伤,二次距下关节固定术和再手术。与螺钉固定相比，通过STA固定钢板可以减少博勒角度的减少损失(WMD=-1.64，95%CI=[-2.96，-0.31]，P=0.06,I2=59%),降低固定失败的发生率(OR=0.32，95%CI=[0.13，0.81]，P=0.78，I2=0%），并减少关节内台阶（WMD=-0.52，95%CI=[-0.87，-0.17]，P=0.66，I2=0%）。
结论：钢板内固定显示出优越的恢复跟骨宽度的能力，保持博勒的角度,尽量减少关节内台阶，从而保持距下关节面更好的复位。此外,钢板内固定的并发症发生率适中，固定失败的发生率较低。因此,我们建议通过STA使用钢板固定，特别是复杂和粉碎性跟骨关节内骨折。
