Cannulated screw fixation versus plate fixation in treating displaced intra-articular calcaneus fractures: a systematic review and meta-analysis

Background Operative treatment has become the current trend for displaced intra-articular calcaneus fracture (DIACF), while using cannulated screw fixation or plate fixation is still controversial for treating DIACF. The purpose of this meta-analysis is to compare the outcome of the two fixation methods. Methods We searched literature comparing cannulated screw fixation and plate fixation from PubMed, Embase, Web of Science, and Cochrane Library. Only randomized controlled trials were included. The outcomes of post-operative function, radiological measurement, time efficiency, and wound complications were pooled in the meta-analysis. Result Seven RCTs with 902 cases of DIACF were included. Pooled results showed the two fixation methods that had similar function satisfactory of AOFAS score (RR = 0.95, 95% CI = [0.83, 1.09], P = 0.47, I 2 = 0%) and Maryland Foot score (RR = 0.93, 95% CI = [0.68, 1.28], P = 0.66, I 2 = 84%). Compared to plate fixation, cannulated screw fixation had better improvement of Bohler’s angle (WMD = 0.56, 95% CI = [0.20, 0.91], P = 0.002, I 2 = 34%) and Gissane’s angle (WMD = 1.36, 95% CI = [0.56, 2.16], P = 0.0008, I 2 = 7%), better recovery of calcaneal height (WMD = 0.49, 95% CI = [0.02, 0.95], P = 0.04, I 2 = 6%), shorter time to operation (WMD = − 2.91, 95% CI = [− 4.99, − 0.84], P = 0.006, I 2 = 97%), less operation time (WMD = − 21.58, 95% CI = [− 37.31, − 5.85], P = 0.007, I 2 = 98%), reduced length of hospital stay (WMD = − 2.00, 95% CI = [− 3.69, − 0.31], P = 0.02, I 2 = 97%), and less wound complications (RR = 0.16, 95% CI = [0.08, 0.32], P < 0.00001, I 2 = 0%). Conclusion Cannulated screw fixation and plate fixation have similar postoperative functional satisfactory. Cannulated screw fixation is superior to plate fixation in reduction quality, time efficiency, and wound complications.