Minimally invasive reduction and percutaneous
fixation versus open reduction and internal
fixation for displaced intra-articular calcaneal
fractures : a systematic review of the literature

Majeed, H; Barrie, J; Munro, W; McBride, D

Abstract

The aim of this article is to systematically identify and analyse research evidence available to compare the outcomes of minimally invasive reduction and percutaneous fixation (MIRPF) versus open reduction and internal fixation (ORIF) for displaced intra-articular calcaneal fractures.


Articles from 2000 to 2016 were searched through MEDLINE (PubMed), Cochrane Library, Embase, ScienceDirect, Scopus and ISI Web of Knowledge using Boolean logic and text words. Of the 570 articles identified initially, nine were selected including three randomized controlled trials and six retrospective comparative studies.


All nine studies had a total of 1,031 patients with 1,102 displaced intra-articular calcaneal fractures. Mean follow-up was 33 months. Of these, 602 (54.6%) were treated with MIRPF and 500 (45.4%) were treated with ORIF.


Overall incidence of wound-related complications in patients treated with MIRPF was 4.3% (0% to 13%) compared with 21.2% (11.7% to 35%) in the ORIF group


Functional outcomes were reported to be better in the minimally invasive group in all studies; however, the results did not reach statistical significance in some studies. All the studies had methodological flaws that put them at either ‘unclear’ or ‘high’ risk of bias for multiple domains.


Overall quality of the available evidence is poor in support of either surgical technique due to small sample size, flaws in study designs and high risk of bias for various elements. Individual studies have reported minimally invasive techniques to be an effective alternative with lower risk of wound complications and better functional outcomes.

Citation

fractures : a systematic review of the literature. EFORT Open Reviews, 3(7), 418-425. https://doi.org/10.1302/2058-5241.3.170043

• Journal Article Type: Article
• Acceptance Date: Mar 31, 2018
• Online Publication Date: Jul 11, 2018
• Publication Date: Jul 19, 2018
• Deposit Date: Jul 27, 2018
• Publicly Available Date: Jul 27, 2018
• Journal: Efort Open Reviews
• Print ISSN: 2396-7544
• Electronic ISSN: 2058-5241
• Publisher: BioScientifica
• Volume: 3
• Issue: 7
• Pages: 418-425
• DOI: https://doi.org/10.1302/2058-5241.3.170043
• Publisher URL: https://doi.org/10.1302/2058-5241.3.170043
• Related Public URLs: https://online.boneandjoint.org.uk/journal/eor