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Cannulated screw fixation versus plate fixation in treating displaced intra-articular calcaneus fractures: a systematic review and meta-analysis

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Abstract

Background

Operative treatment has become the current trend for displaced intra-articular calcaneus fracture (DIACF), while using cannulated screw fixation or plate fixation is still controversial for treating DIACF. The purpose of this meta-analysis is to compare the outcome of the two fixation methods.

Methods

We searched literature comparing cannulated screw fixation and plate fixation from PubMed, Embase, Web of Science, and Cochrane Library. Only randomized controlled trials were included. The outcomes of post-operative function, radiological measurement, time efficiency, and wound complications were pooled in the meta-analysis.

Result

Seven RCTs with 902 cases of DIACF were included. Pooled results showed the two fixation methods that had similar function satisfactory of AOFAS score (RR = 0.95, 95% CI = [0.83, 1.09], P = 0.47, I2 = 0%) and Maryland Foot score (RR = 0.93, 95% CI = [0.68, 1.28], P = 0.66, I2 = 84%). Compared to plate fixation, cannulated screw fixation had better improvement of Bohler’s angle (WMD = 0.56, 95% CI = [0.20, 0.91], P = 0.002, I2 = 34%) and Gissane’s angle (WMD = 1.36, 95% CI = [0.56, 2.16], P = 0.0008, I2 = 7%), better recovery of calcaneal height (WMD = 0.49, 95% CI = [0.02, 0.95], P = 0.04, I2 = 6%), shorter time to operation (WMD =  − 2.91, 95% CI = [− 4.99, − 0.84], P = 0.006, I2 = 97%), less operation time (WMD =  − 21.58, 95% CI = [− 37.31, − 5.85], P = 0.007, I2 = 98%), reduced length of hospital stay (WMD =  − 2.00, 95% CI = [− 3.69, − 0.31], P = 0.02, I2 = 97%), and less wound complications (RR = 0.16, 95% CI = [0.08, 0.32], P < 0.00001, I2 = 0%).

Conclusion

Cannulated screw fixation and plate fixation have similar postoperative functional satisfactory. Cannulated screw fixation is superior to plate fixation in reduction quality, time efficiency, and wound complications.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Funding

This study is supported by Beijing municipal science and technology commission (grant number Z171100001017209) and National Natural Science Foundation of China (grant number 81972107 and 82072494).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China

    Qiuyuan Wang, Nianfei Zhang, Wanshou Guo, Weiguo Wang & Qidong Zhang

  2. Graduate School of Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China

    Qiuyuan Wang

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Contributions

Qidong Zhang and Weiguo Wang contributed to the study design. Qiuyuan Wang contributed to the drafting of the manuscript. Qiuyuan Wang and Nianfei Zhang conducted the literature search, quality assessment, data collection, and analysis. Wanshou Guo solved the cases of doubt. Weiguo Wang reviewed and edited the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Weiguo Wang or Qidong Zhang.

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Wang, Q., Zhang, N., Guo, W. et al. Cannulated screw fixation versus plate fixation in treating displaced intra-articular calcaneus fractures: a systematic review and meta-analysis. International Orthopaedics (SICOT) 45, 2411–2421 (2021). https://doi.org/10.1007/s00264-021-05141-y

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