title: Cannulated screw fixation and plate fixation for displaced intra-articular calcaneus fracture: A meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Displaced intra-articular calcaneus fractures (DIACFs) are the most common type of calcaneus fracture. The differences in therapeutic effectiveness between cannulated screw fixation (CSF) and plate fixation are still unclear. Thus, in this meta-analysis, we evaluated the therapeutic effectiveness of these two fixation methods.
  
  
  METHODS
  We searched for all publications on DIACFs fixated with cannulated screws or plates in the following electronic databases: Pubmed, Cochrane, Embase and CNKI. Only randomized controlled studies were included. The Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0) was applied for analysis. The primary outcomes were American Orthopedic Foot and Ankle Society score (AOFAS), improvement of Bohler's angle, improvement of Gissane's angle and the width of the calcaneus. Outcomes were reported as the standard mean difference (SMD) or relative risk (RR) with the 95% confidence interval (CI). A random effects model was used to assess the pooled data.
  
  
  RESULTS
  Five randomized controlled studies met our inclusion criteria, and a total of 707 patients were involved. There was no statistically significant difference between the cannulated screw fixation group and the plate fixation group in terms of excellent and good AOFAS scores (RR = 1.01, 95%CI 0.91 to 1.13, P = 0.79), improvement of Bohler's angle (SMD = 0.12, 95%CI -0.03 to 0.28, P = 0.12), improvement of Gissane's angle (SMD = 0.09, 95%CI -0.28 to 0.26, P = 0.30), or the width of the calcaneus (SMD = -0.07, 95%CI -0.24 to 0.10, p = 0.45). Compared with plate fixation, CSF showed a significant reduction in the duration of surgery (SMD = -1.74, 95%CI, -3.35 to -0.13, P = 0.03) and rate of complications (RR = 0.25, 95%CI, 0.15 to 0.44, P＜0.00001).
  
  
  CONCLUSIONS
  Cannulated screw fixation and plate fixation have similar fixation effectiveness and functional outcomes in the treatment of displaced intra-articular calcaneus fractures. Due to the shorter duration of surgery and low rate of complications, cannulated screw fixation is superior to plate fixation. However, further studies are needed to evaluate cannulated screw fixation for various Sanders types of calcaneus fractures.
authors: Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors: Baoyou
authors: B
authors: Fan
authors: Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors: Xianhu
authors: X
authors: Zhou
authors: Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors: Zhijian
authors: Z
authors: Wei
authors: Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors: Yiming
authors: Y
authors: Ren
authors: Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors: Wei
authors: W
authors: Lin
authors: Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors: Yan
authors: Y
authors: Hao
authors: Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors: Guidong
authors: G
authors: Shi
authors: Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China. Electronic address: sqfeng@tmu.edu.cn.
authors: Shiqing
authors: S
authors: Feng
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery; D002404:Catheterization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Cannulated screws fixation; Displaced intra-articular calcaneus fracture; Meta-analysis; Plate fixation