Operative vs nonoperative treatment of displaced intraarticular calcaneal fracture: A meta-analysis of randomized controlled trials

AIM: To investigate clinical efficacy of displaced intraarticular calcaneal fracture(DIACF) following operation and nonoperation. METHODS: Literature search was performed of Pub Med and Cochrane Library by two independent authors to identify randomized controlled trials(RCTs) comparing operative vs nonoperative treatment of DIACF from inception to December 31 st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or randomeffects models were adopted with P > 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS: Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job(P = 0.006). No statistical differences were found between the two groups in residual pain(P = 0.33), shoe fitting problems(P = 0.07), limited walking distance(P = 0.56) or secondary late arthrodesis(P = 0.38). However, operative treatment was associated with a higher complication rate(P = 0.003). Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems(P < 0.0001) in operative group, the two groups had similar complication rate in deep wound infection(P = 0.34),compartment syndrome(P = 0.46), thromboembolism(P = 0.32), reflex sympathetic dystrophy(P = 0.51) or traumatic arthritis secondary to DIACF(P = 0.43).CONCLUSION: Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.