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Joint Diseases and
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Original Article · Open access

A meta-analysis of Allgöwer-Donati versus interrupted vertical mattress suturing in preventing postoperative incisional complications of calcaneal fracture surgery: A systematic review and meta-analysis

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Hua-Xin Lai

Department of Orthopaedics I, Fujian University of Traditional Chinese Medicine Affiliated Sanming Hospital of Integrated Medicine, Sanming City, China

ORCID: 0009-0005-4665-1946

Li-Ping Peng

Department of Orthopaedics I, Fujian University of Traditional Chinese Medicine Affiliated Sanming Hospital of Integrated Medicine, Sanming City, China

ORCID: 0009-0008-4752-8212

Lian-Hua Wu

Department of Orthopaedics I, Fujian University of Traditional Chinese Medicine Affiliated Sanming Hospital of Integrated Medicine, Sanming City, China

ORCID: 0009-0008-2355-5101

Wei Ye

Department of Orthopaedics I, Fujian University of Traditional Chinese Medicine Affiliated Sanming Hospital of Integrated Medicine, Sanming City, China

ORCID: 0009-0007-7749-7843

Abstract

Objectives: In this meta-analysis, we systematically compared the efficacy of the Allgöwer-Donati suture technique versus the interrupted vertical mattress suture technique in preventing postoperative incision complications following calcaneal fracture surgery.

Materials and methods: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted from their inceptions up to May 2025. This study included randomized-controlled trials (RCTs) involving adults (18-80 years) with closed calcaneal fractures who underwent open reduction and internal fixation (ORIF) via a lateral incision. The primary outcomes were surgical suture time, wound suture time, drainage tube removal time, and the incidence of postoperative complications. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using fixed-effect or random-effects models based on heterogeneity (I2 statistic).

Results: Eight RCTs comprising 640 patients were included. The Allgöwer-Donati technique significantly reduced surgical suture time (SMD = 0.81, 95% CI 0.22 to 1.39, p = 0.007; I2 = 47%), drainage tube removal time (SMD = 4.94, 95% CI 4.42-5.47, p < 0.00001; I2 = 65%), and wound suture time (SMD = –3.36, 95% CI –3.90 to –2.81, p < 0.00001; I2 = 34%) compared to the interrupted vertical mattress technique. However, there was no significant difference in the overall rate of postoperative complications between the two techniques (OR = 1.32, 95% CI 0.95-1.82, p = 0.10; I2 = 0%).

Conclusion: The Allgöwer-Donati suture technique offers significant advantages in operative efficiency by reducing suture times and drainage duration without increasing the risk of postoperative complications compared to the interrupted vertical mattress technique. It represents a promising suturing option for calcaneal fracture surgery, particularly in settings valuing procedural efficiency.

Declarations

Author Contributions

YW.: Conception and design of the research, critical revision of the manuscript for intellectual content; L.H.X.: Acquisition of data; L.H.X., P.L.P., W.L.H.: Analysis and interpretation of the data; Y.W., L.H.X., P.L.P., W.L.H.: Statistical analysis; L.H.X.: Writing of the manuscript. All authors have read and approved the manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

This study was supported by Efficacy of Buzhong Yiqi Decoction Combined with Allgower-Donati Suture for Postoperative Wound Complications after Calcaneal Fracture Surgery, No.2023J011756.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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