title: Operative Versus Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  To compare the clinical outcomes of operative and nonoperative treatment for displaced intra-articular calcaneal fractures (DIACFs).
  
  
  METHODS
  PubMed, Embase, Cochrane library, and ClinicalTrial.gov.
  
  
  METHODS
  Randomized controlled trials comparing operative and nonoperative treatment for DIACFs.
  
  
  METHODS
  Information on study methods and clinical outcomes.
  
  
  RESULTS
  We performed data synthesis on relevant clinical outcomes. Weighted mean differences with 95% confidence intervals were calculated for continuous data and relative risks with 95% confidence intervals were calculated for dichotomous data. A fixed-effect model or a random-effect model was used.
  
  
  RESULTS
  Seven randomized controlled trials involving 908 patients were included. Operative treatment for DIACFs reduced problems associated with shoe wear and increased walking ability but increased the risks of overall complications and infection. There were no significant differences between the groups in American Orthopaedic Foot and Ankle Society scores, The Short Form (36) Health Survey, return to work, rate of subsequent subtalar fusion, or the rate of reflex sympathetic dystrophy.
  
  
  CONCLUSIONS
  This meta-analysis documented that when surgery was performed correctly, better shoe wear and improved walking ability could be expected. These outcomes seemed to be based on the surgeon's ability to obtain an acceptable reduction. Benefits were tempered by the increase in wound complications associated with this intervention.
  
  
  METHODS
  Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Feng
authors.initials: F
authors.lastname: Lin
authors.forename: Erman
authors.initials: E
authors.lastname: Chen
authors.forename: Deting
authors.initials: D
authors.lastname: Xue
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Pan
mesh_terms: D064386:Ankle Fractures / Q000453:epidemiology* / Q000628:therapy*; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery; D015897:Comorbidity; D000072700:Conservative Treatment / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012307:Risk Factors; D016896:Treatment Outcome