Operative Versus Nonoperative Treatment for Displaced Intra-articular Calcaneal Fractures: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 WANG Chong , TIAN He , QU Jianhua , TIAN Zheng

Corresponding author：

WANG Chong, Email: wiltion@xj.cninfo.net

Keywords：

Displaced; Intra-articular calcaneal fractures; Operative treatment; Nonoperative treatment; Randomized controlled trials; Systematic review

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Objective 　To compare the effects of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures.
Methods 　All randomized controlled trials (RCTs) of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures were identified. Quality assessment and data extraction were performed by two reviewers independently.
Results 　Four published trials involving 530 patients were included. All studies compared operative with nonoperative treatment. It was clear that operative treatment was superior to nonoperative treatment in terms of helping patients back to work, reducing problems wearing shoes, expanding the range of motion of subtalar joint, and improving the recovery of Bohler’s angle. As for foot pain, there was no difference between the two methods. Because the outcome measures varied across the trials, a meta-analysis could not be performed.
Conclusions 　Both operative and nonoperative treatments produce comparable long-term outcomes in the treatment of displaced intra-articular calcaneal fractures. Because of the poor reporting of outcomes, it is not possible to determine if there is any significant difference in outcome measures apart from those listed above. More trials with high methodological quality are needed.

Citation： WANG Chong,TIAN He,QU Jianhua,TIAN Zheng. Operative Versus Nonoperative Treatment for Displaced Intra-articular Calcaneal Fractures: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2007, 07(4): 276-282. doi: Copy

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3.	Tennent TD, Calder PR, Salisbury RD, et al. The operative management of displaced intra-atticular fractures of the calcaneum: a two centre study using a defined protocol. Injury, 2001, 32: 491-496.
4.	Essex- Lopresti P. The mechanism, reduction technique, and result in fractures of the os calcis. Br J Surg, 1952, 39: 395-419.
5.	Sanders R, Fortin P, DiPasquale A, et al. Operative treatment in 120 displaced intra-articular calcaneal fractures: results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
6.	Lowery RB, Calhoun JH. Fractures of the calcaneus. Part II: Treatment. Foot Ankle Int, 1996, 17: 360-366.
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8.	Zwipp H, Rammelt S, Barthel S. Calcaneal fractures: open reduction and internal fixation. Injury, 2004, 35(2) : 46-54.
9.	Rammelt S, Zwipp H. Calcaneus fracture: facts, controversies and recent developments. Injury, 2004, 35(5) : 443-461.
10.	Howard JL,Buckley R,McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma, 2003, 17 (4) : 241-249.
11.	Kenwright J. Fractures of the calcaneum. J Bone Joint Surg Br, 1993, 75: 176-177.
12.	Lowery RB, Calhoun JH. Fractures of the calcaneus. Part I: Anatomy, injury mechanism, and classification. Foot Ankle Int, 1996, 17: 230-235.
13.	Joni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
14.	Parmar HV, Triffitt PD, Gregg PJ. Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. J Bone Joint Surg Br, 1993, 75( ): 932-937.
15.	O’Farrell DA, O’Byrne JM, McCabe JP, et al. Fractures of the os calcis: improved results with internal fixation. Injury, 1993, 24(4): 263-265.
16.	Thordarson DB, Krieger LE. Operative vs. nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int, 1996, 17(1): 2-9.
17.	Buckley, R, Tough, S, McCormack, R, et al. Operative versus non-operative treatment of displaced intra-articular calcaneal fractures— a prospective randomized controlled multi-center trial. J Bone Joint Surg, 2002, 84: 1733–1744.

1. Sanders R Displaced intra-articular fracture of the calcaneus. J Bone Joint Surg, 2000, 82(2): 225-250.
2. Heppnstall RB. Fracture Treatment and Healing. Philadel-phia: WB. Saunders Company, 1980, 860-868.
3. Tennent TD, Calder PR, Salisbury RD, et al. The operative management of displaced intra-atticular fractures of the calcaneum: a two centre study using a defined protocol. Injury, 2001, 32: 491-496.
4. Essex- Lopresti P. The mechanism, reduction technique, and result in fractures of the os calcis. Br J Surg, 1952, 39: 395-419.
5. Sanders R, Fortin P, DiPasquale A, et al. Operative treatment in 120 displaced intra-articular calcaneal fractures: results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
6. Lowery RB, Calhoun JH. Fractures of the calcaneus. Part II: Treatment. Foot Ankle Int, 1996, 17: 360-366.
7. Gurtowski J, Ries MD, Levin PE. Fractures and dislocations of the foot. In: Dee R, Mango E, Hurst L editor(s). Principles of orthopaedic practice. USA: McGraw-Hill Inc, 1989, 1242-1260.
8. Zwipp H, Rammelt S, Barthel S. Calcaneal fractures: open reduction and internal fixation. Injury, 2004, 35(2) : 46-54.
9. Rammelt S, Zwipp H. Calcaneus fracture: facts, controversies and recent developments. Injury, 2004, 35(5) : 443-461.
10. Howard JL,Buckley R,McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma, 2003, 17 (4) : 241-249.
11. Kenwright J. Fractures of the calcaneum. J Bone Joint Surg Br, 1993, 75: 176-177.
12. Lowery RB, Calhoun JH. Fractures of the calcaneus. Part I: Anatomy, injury mechanism, and classification. Foot Ankle Int, 1996, 17: 230-235.
13. Joni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
14. Parmar HV, Triffitt PD, Gregg PJ. Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. J Bone Joint Surg Br, 1993, 75( ): 932-937.
15. O’Farrell DA, O’Byrne JM, McCabe JP, et al. Fractures of the os calcis: improved results with internal fixation. Injury, 1993, 24(4): 263-265.
16. Thordarson DB, Krieger LE. Operative vs. nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int, 1996, 17(1): 2-9.
17. Buckley, R, Tough, S, McCormack, R, et al. Operative versus non-operative treatment of displaced intra-articular calcaneal fractures— a prospective randomized controlled multi-center trial. J Bone Joint Surg, 2002, 84: 1733–1744.

Chinese Journal of Evidence-Based Medicine

Operative Versus Nonoperative Treatment for Displaced Intra-articular Calcaneal Fractures: A Systematic Review

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