Meta-analysis of two surgical approaches for calcaneal fractures: sinus tarsi versus extensile lateral approach

Background: There remains a controversy between extensile lateral approach and sinus tarsi approach (STA) to treat calcaneal fractures. The aim of this study is to evaluate the medium- and long-term outcomes of the STA versus extensile lateral approach in terms of intraoperative variables, quality of alignment on a lateral radiograph incidence of wound healing complication, visual analogue scale and American Orthopaedic Foot and Ankle Society for the treatment of calcaneal fractures.

Methods: Relevant original studies were searched in PubMed, Medline and Embase and Chinese National Knowledge Infrastructure (January 1990 and November 2015). Studies included in this meta-analysis had to compare the effectiveness or complications and provide sufficient data of interest. The patients treated by both methods were similar statistically in age, gender or injury mechanism. The Stata 11.0 was used to analyse all data.

Results: Eight studies involving 564 participants were included. STA was associated with decreased incidence of overall complications (odds ratio: 0.14; 95% confidence interval (CI): 0.05-0.38) and wound healing complications (odds ratio: 0.16; 95% CI: 0.06-0.41) and lower visual analogue scale score (standardized mean difference: -1.28; 95% CI: -2.27 to -0.29). However, there were no significant differences in other adverse events including the quality of anatomical reduction and the excellent and good rate according to the American Orthopaedic Foot and Ankle Society.

Conclusion: The existing evidence supports STA to be a better approach for treating calcaneal fractures, and this might aid in the management of this injury.