title: Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base.
abstract: BACKGROUND
  The extensile lateral approach (ELA) has been widely performed for displaced intra-articular calcaneal fractures (DIACFs), and wound complications remain a significant problem. As a minimal incision technique, the sinus tarsi approach (STA) was designed to overcome this disadvantage. There were already many reports about this approach but the conclusions were not completely consistent. Based on the current evidence, we performed this meta-analysis to compare the STA with ELA in the management of DIACF and expected to draw a certain and meaningful conclusion.
  
  
  METHODS
  All potentially relevant randomized controlled trials (RCTs) and cohort studies (CSs) were searched in the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrial.gov. The desirable outcomes including wound complications, excellent and good rate, secondary surgery rate and Böhler's angle were extracted. RCT studies were assessed using the Risk of Bias Tool recommended by the Cochrane Collaboration, and cohort studies were evaluated using the Newcastle-Ottawa Scale. The data of RCTs and cohorts were pooled respectively using the fixed-effect model or random-effect model. Mean differences with 95% confidence intervals (CIs) were calculated for continuous data, and relative risks (RRs) with 95% CIs were calculated for dichotomous data. Statistical heterogeneity was assessed with the Q test and I2. Sensitivity analysis was developed to assess the reliability of pooled results.
  
  
  RESULTS
  Seven studies including two RCTs and five CSs were eligible for the meta-analysis. No matter RCTs or CSs, the pooled data all showed that STA group had a lower incidence of wound complications than that in the ELA group and no significant difference was found in excellent and good rate and the recovery of Böhler's angle between the two groups. The CSs also showed that the STA group had a lower incidence of secondary surgeries than that in the ELA group.
  
  
  CONCLUSIONS
  Through a STA, we not only can reduce the problems in wound healing but also achieve nearly the same adequate restoration of DIACF along with the similar functional outcomes compared with through an ELA.
authors.affiliation: Department of Orthopaedics, The Third Affiliated Hospital of Sun Yat-sen University, NO. 2693 Kaichuang Road, Guangzhou, 510100, People's Republic of China. yaoww001@126.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Yao
authors.affiliation: Department of Orthopaedics, The Third Affiliated Hospital of Sun Yat-sen University, NO. 2693 Kaichuang Road, Guangzhou, 510100, People's Republic of China.
authors.forename: Tangzhao
authors.initials: T
authors.lastname: Liang
authors.affiliation: Department of Orthopaedics, The Third Affiliated Hospital of Sun Yat-sen University, NO. 2693 Kaichuang Road, Guangzhou, 510100, People's Republic of China.
authors.forename: Yichun
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Orthopaedics, The Third Affiliated Hospital of Sun Yat-sen University, NO. 2693 Kaichuang Road, Guangzhou, 510100, People's Republic of China.
authors.forename: Gang
authors.initials: G
authors.lastname: Hou
authors.affiliation: Department of Orthopaedics, The Third Affiliated Hospital of Sun Yat-sen University, NO. 2693 Kaichuang Road, Guangzhou, 510100, People's Republic of China.
authors.forename: Lulu
authors.initials: L
authors.lastname: Lv
authors.affiliation: Department of Orthopaedics, The Third Affiliated Hospital of Sun Yat-sen University, NO. 2693 Kaichuang Road, Guangzhou, 510100, People's Republic of China.
authors.forename: Junbin
authors.initials: J
authors.lastname: Zhang
mesh_terms: D016512:Ankle Injuries / Q000601:surgery*; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery; D015331:Cohort Studies; D019317:Evidence-Based Medicine / Q000379:methods; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic
keywords: Calcaneus; ELA; Fracture; STA