Minimally invasive surgical techniques compared to an extensile lateral approach in the management of displaced intra-articular calcaneal fractures. A systematic review and meta-analysis of randomised controlled trials

Abstract

Background: Developments in minimally invasive surgical techniques (MIS) have sparked debate over the optimal intervention for calcaneal fractures. This meta-analysis compares the extensile lateral approach (ELA) to two MIS techniques; the sinus tarsi approach and percutaneous approaches.

Methods: A systematic search was conducted across seven databases for randomised control trials (RCTs). The clinical outcomes were wound complications, functional scores (American Orthopaedic Foot & Ankle Society score, and Maryland Foot Score) and radiological measures (Böhler's and Gissane's angles).

Results: Fourteen RCTs (n = 1367; mean age: 36.3 years; 25.7 % female) were included. MIS significantly reduced wound complications compared to ELA (RR 6.48, 95 %CI 4.03-10.41, p < 0.00001, n = 1380, GRADE: High). Functional scores favoured MIS, and radiological outcomes were equivalent.

Conclusions: Both MIS techniques reduce wound complications, improve functional outcomes, and achieve comparable anatomical reduction, making them suitable alternatives to the extensile lateral approach, to significantly improve patient's outcomes.

Level of evidence: Level 1.

Keywords: Calcaneal fracture; Extensile lateral approach; Meta-analysis; Minimally invasive; Wound complications.