Percutaneous screw osteosynthesis for the treatment of intra-articular displaced calcaneus fractures.

PURPOSE: This systematic review investigates how percutaneous screw osteosynthesis for the treatment of intra-articular displaced calcaneus fractures differs from open reduction and internal fixation (ORIF). METHODS: Randomized controlled trials and controlled clinical trials investigating adults with closed intra-articular displaced calcaneus fracture (Sanders type II - IV) treated with percutaneous screw osteosynthesis or ORIF were included. Severe vascular and neurological diseases or polytrauma patients were excluded. On January 29, 2024, five databases and two trial registries were searched. The Risk of Bias Tool of Cochrane was used. The protocol was registered on PROSPERO (CRD42021244695). RESULTS: Five studies with 654 participants (682 calcaneus fractures) were included. The risk of bias was moderate to high. None of the single studies found a significant difference regarding severe complications. However, meta-analysis revealed a lower risk for the percutaneous screw osteosynthesis group compared to ORIF (relative risk (RR) 0.40 (95% Confidence Interval [0.17; 0.92]; I² = 0%; p = 0.03). One study showed less pain in the percutaneous screw osteosynthesis group up to 4 weeks postoperatively. No study assessed health-related quality of life. CONCLUSION: Percutaneous screw osteosynthesis in intra-articular displaced calcaneus fractures might be beneficial to ORIF in terms of minor and severe complications, and pain at four weeks. Percutaneous screw osteosynthesis could be an additional, less invasive treatment option, depending on the complexity of the injury. However, studies with larger sample sizes are needed to confirm these results and explore long-term complications.