Closed percutaneous reduction versus mini-open sinus tarsi approach for fixation of displaced intra-articular calcaneal fractures: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared closed percutaneous reduction (PR) with the mini-open sinus tarsi approach (STA) for acute displaced intra-articular calcaneal fractures. Eight studies included 837 patients with Sanders type II or III fractures. PR was associated with fewer overall complications than STA (RR 0.47, 95% CI [0.27-0.83], p = 0.009). Functional and most radiological outcomes were comparable; the small AOFAS score difference favouring PR was judged of doubtful clinical relevance. The authors conclude that PR may be an acceptable strategy for these less complex fracture patterns.

Key findings

• PR was associated with a 53% risk reduction in overall complications versus STA (RR 0.47, 95% CI [0.27-0.83], p = 0.009), including wound complications.
• AOFAS scores marginally favoured PR (MD 0.82 points, p = 0.034), but the difference had doubtful clinical relevance.
• Radiological parameters were comparable overall, although calcaneal width remained wider with PR.
• PR was associated with shorter times to surgery, hospital stays and intra-operative times; pooled estimates had high heterogeneity.

Why it matters

For Sanders type II and III fractures, the findings suggest that a closed percutaneous approach may reduce complications without a meaningful loss in functional or most radiological outcomes compared with the mini-open sinus tarsi approach. The modest functional-score difference should be interpreted cautiously, and the evidence does not establish superiority across more complex fracture patterns.

What to keep in mind

The review included eight comparative studies, and the pooled estimates for operative timing and length of stay had high heterogeneity. The findings apply to Sanders type II and III fractures.