title: Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base.
abstract: OBJECTIVE
  Controversy still surrounds the optimal treatment for patients with displaced intra-articular calcaneal fractures (DIACF). An up-to-date meta-analysis was performed to evaluate clinical effectiveness of surgical treatment for DIACF compared with nonsurgical treatment.
  
  
  METHODS
  We systematically searched four electronic databases (Medline, BIOSIS, Cochrane library and Google Scholar) to identify randomised controlled trials (RCTs) and clinical controlled trials (CCTs) in which surgical treatment was compared with nonsurgical treatment of DIACF from 1980 to 2011. Trial quality was assessed using the modified Jadad scale and effective data were pooled for meta-analysis.
  
  
  RESULTS
  Ten studies (six RCTs and four CCTs) with a total of 891 participants were screened. Results showed that surgical treatment was superior to nonsurgical treatment in better recovery of the Böhler angle (P < 0.0001), more stable calcaneal height (P = 0.0009) and width (P < 0.00001). Moreover, fewer surgically treated patients needed increased shoe size (P = 0.0004) and more were able to resume pre-injury work (P = 0.004) than the nonsurgical patients. No significant difference was identified between the two methods regarding the incidence of residual pain (P = 0.49). However, operative management was associated with a higher risk of complications (P = 0.008).
  
  
  CONCLUSIONS
  Although surgical repair may increase the complication probability, it is the price that has to be paid for better reconstruction of the calcaneus and better functional results. Taken as a whole, surgery is probably the optimal choice in DIACF treatment.
authors.affiliation: Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
authors.forename: Nan
authors.initials: N
authors.lastname: Jiang
authors.forename: Qing-rong
authors.initials: QR
authors.lastname: Lin
authors.forename: Xi-cai
authors.initials: XC
authors.lastname: Diao
authors.forename: Liang
authors.initials: L
authors.lastname: Wu
authors.forename: Bin
authors.initials: B
authors.lastname: Yu
mesh_terms: D002111:Calcaneus / Q000293:injuries*; D019317:Evidence-Based Medicine; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D019637:Orthopedic Procedures; D020127:Recovery of Function; D016896:Treatment Outcome