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

Objective To compare the effects of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures.Methods Randomized controlled trials (RCT) and quasi-randomized controlled trials(quasi-RCT) were identified from MEDLINE (1966-2006), EMBASE (1966-2006), Cochrane Library (Issue2, 2006), Cochrane Musculoskeletal Injuries Group Database(2006.12),and CBM disc (1979- 2006.12).The relative orthopaedic papers pulished in Chinese journals and meeting materials in recent 5 years were collected by hand.RCTs and quasi-RCTs were included. Data were extracted by two reviewers with designed extraction form.The quality of trials was critically assessed. RevMan4.2.8software was used for data analysis.Results Four published trials including 530 patients were included. All studies compared operative with nonoperative treatment.It was clear that operative treatment was superior to nonoperative treatment in term of patients back to work,reducing problems wearing shoe, expanding the rang 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 measuers varied arcoss the trials, a meta-analysis could not be performed. Conclusion 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 methodology quality are needed.