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Original Article · Open access

Comparison between intramedullary nail and conventional plate for displaced intra-articular calcaneal fractures: A meta-analysis

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Xin Fu

Department of Orthopedics, Tianjin Hospital, Tianjin, China

ORCID: 0000-0002-6786-9259

Zhong-bo Deng

Department of Hand Surgery, Tianjin Hospital, Tianjin, China

ORCID: 0009-0001-4542-0311

Gui-xin Wang

Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, China

ORCID: 0000-0001-7960-2861

Chen-guang Wang

Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China

ORCID: 0000-0003-4622-6358

Zhi-jun Li

Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China

ORCID: 0000-0003-1373-6837

Abstract

Objectives: This study aimed to compare the efficacy and safety of the intramedullary nail and conventional plate for the treatment of displaced intra-articular calcaneal fractures from clinical comparative trials.

Materials and methods: A comprehensive search of English databases was carried out in the Springer, PubMed, ScienceDirect, Web of Science, and Cochrane Library databases until September 2023. Studies on calcaneal fractures treated by an intramedullary nail or a plate were considered for inclusion. Endpoints included duration of operation, length of hospital stay, the Visual Analog Scale (VAS) score, postoperative functional score, radiological parameters, and complications. The mean difference (MD) and risk difference (RD) as the combined variables, as well as the 95% confidence intervals, (CIs) were calculated.

Results: Five retrospective controlled studies covering 473 feet at the one-year follow-up met the inclusion criteria. The metaanalysis demonstrated that there were significant differences in the duration of operation (MD: –10.81; 95% CI: –16.32, –5.31; p=0.0001), length of hospital stay (MD: –3.65; 95% CI: –4.35, –2.95; p<0.00001). No significant differences were found regarding postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (MD: 0.36; 95% CI: –3.89, 4.61; p=0.87), VAS (MD: 1.95; 95% CI: –0.30, 4.21; p=0.09), or postoperative Böhler angle (MD: 0.94; 95% CI: –0.04, 1.92; p=0.06) between the two groups. The incidence of total complications (RD: –0.31; 95% CI: –0.46, –0.17; p<0.0001) and wound-healing complications (RD: –0.16; 95% CI: –0.30, –0.03; p=0.02) were lower in the intramedullary nail group. There were no significant differences in the incidences of revision surgery, implant removal, superficial wound infection, deep infection, and nonunion.

Conclusion: Compared to conventional plates, the intramedullary nail showed a shorter duration of operation, reduced length of hospital stay, and fewer postoperative total complications and wound-healing complications in treating displaced intra-articular calcaneal fractures.

Declarations

Ethics Committee Approval

No ethical approval was required, as all data in this meta-analysis were derived from previously published research. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Response: Contributed to conception and design of this study: X.F., Z.B.D., C.G.W., Z.J.L.; Study selection and data extraction of the finally included studies were done independently assessed the methodological quality of each included study: X.F., Z.B.D., C.G.W.; Contributed to preparation of the manuscript: X.F., G.X.W., Z.J.L.; The final version of the article was approved by all the authors. Thank you very much.

Conflict of Interest

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

Financial Disclosure

The authors are grateful for the support by Tianjin Health Science and Technology Project (No. ZC20096 and RC20120) and Tianjin Science and Technology Planning Project (No. 20JCYBJC01440).

Data Sharing Statement

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

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