Meta‐analysis of two surgical approaches for calcaneal fractures: sinus tarsi versus extensile lateral approach

Zhang, Fei; Tian, Hongtao; Li, Shilun; Liu, Bo; Dong, Tieli; Zhu, Yanbin; Zhang, Yingze

doi:10.1111/ans.13869

Cited by 32 publications

(25 citation statements)

References 31 publications

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“…Previous studies comparing the therapeutic efficacy and clinical outcomes of ORIF via ELA or STA have showed no significant differences. 16,32,34,48 From our results, the clinical outcomes including the Bohler's and Gissane angle, VAS scores, AOFAS scores were in accord with previous studies. Nevertheless, to the best of our knowledge, no studies comparing the direct costs and effectiveness of two techniques in China were conducted.…”

Section: Discussionsupporting

confidence: 90%

Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures

Zhou

et al. 2020

Preprint

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Background Extensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons. And comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of CUA about optimal healthcare for type II/III calcaneus fracture. Method A single-center, retrospective study was conducted in which basic characteristics, clinical outcomes and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life-years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY. Results 109 patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory and radiographic evaluation expense, surgery, anesthesia and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group ( P <.001, P =.008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days ( P <.001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8±2835.2/QALY and $7914.9 ± 1822.0/QALY respectively and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference. Conclusion Both ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials.

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Section: Discussionsupporting

confidence: 90%

Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures

Zhou

et al. 2020

Preprint

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“…Previous studies comparing the therapeutic e cacy and clinical outcomes of ORIF via ELA or STA have showed no signi cant differences. [37][38][39][40] From our results, the clinical outcomes including the Bohler's and Gissane angle, VAS scores, AOFAS scores were in accord with previous studies. Nevertheless, to the best of our knowledge, no studies comparing the direct costs and effectiveness of two techniques in China were conducted.…”

Section: Discussionsupporting

confidence: 90%

Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures

Zhou

et al. 2020

Preprint

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Background. Extensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons and comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of cost-utility analysis (CUA) about optimal healthcare for type II/III calcaneus fracture.Method. A single-center, retrospective study was conducted in which basic characteristics, clinical outcomes and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life-years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY.Results. 109 patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory and radiographic evaluation expense, surgery, anesthesia and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group (P＜.001, P=.008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days (P＜.001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8±2835.2/QALY and $7914.9 ± 1822.0/QALY respectively and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference.Conclusion. Both ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials.

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“…The 3 typical approaches used for calcaneal osteosynthesis are the lateral approach, medial approach, and combined lateral and medial approach. We chose the lateral approach in the present study, because the extensile lateral approach has achieved wide popularity for surgical fixation by providing excellent exposure, allowing access to manipulate and fix the fracture fragments (39,40). In addition, De Groot (41) found that complications after the lateral approach for calcaneal fractures did not influence the mid-to long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

Cao

et al. 2018

The Journal of Foot and Ankle Surgery

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Calcaneal fractures, often caused by a fall from a height, are the most common injuries encountered by orthopedic surgeons. Currently, open anatomic reduction and internal fixation (ORIF) is considered a valuable treatment of displaced intraarticular fractures of the calcaneus; however, the need for bone grafting in the treatment is still controversial. Therefore, in the present study, we investigated the outcomes of 2 methods (with and without bone grafting) used for the surgical treatment of Sanders type III calcaneal fractures. From January 2013 to September 2015, 57 cases (55 patients) with displaced Sanders type III calcaneal fractures (53 unilateral and 2 bilateral) were enrolled. The patients were divided into 2 groups: group I was treated by ORIF with bone grafting (n = 28) and group II was treated by ORIF without bone grafting (n = 29). The radiologic evaluation included Böhler's angle, Gissane's angle, and the height and width of the calcaneum. In addition, the American Orthopaedic Foot and Ankle Society questionnaires and visual analog scale were completed by the patients. During the follow-up period, no differences were found in the outcome measures (Böhler's angle, p = .447; Gissane's angle, p = .599; calcaneal height, p = .065; calcaneal width p = .077; and American Orthopaedic Foot and Ankle Society questionnaires, p = .282) with or without bone grafting. The only difference between the 2 groups was the occurrence of postoperative pain (p = .024 and p = ≤ .05), which was greater in the patients who had undergone bone grafting. We have provided evidence that bone grafting with internal fixation in the treatment of intraarticular calcaneal fractures failed to improve the restoration of Böhler's angle or Gissane's angle. No statistically significant difference was found in the short-term outcomes between the 2 methods used for the surgical treatment of Sanders type III calcaneal fractures.

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Meta‐analysis of two surgical approaches for calcaneal fractures: sinus tarsi versus extensile lateral approach

Abstract: The existing evidence supports STA to be a better approach for treating calcaneal fractures, and this might aid in the management of this injury.

Cited by 32 publications

References 31 publications

Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures

Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures

Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures

Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

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