Pj. Richards et S. Bridgman, Review of the radiology in randomised controlled trials in open reduction and internal fixation (ORIF) of displaced intraarticular calcaneal fractures, INJURY, 32(8), 2001, pp. 633-636
Citations number
15
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
The aim of this study was to assess the radiological evaluation of all pros
pective, randomised, controlled trails of displaced intraarticular calcanea
l fractures. A systematic review of the literature, of which only three of
296 references were randomised and controlled, were examined in a blinded f
ashion. All had preoperative coronal CT for Sander's classification and use
d a lateral surgical approach or conservative treatment. Thordason (15 pati
ents/11 controls) used interoperative lateral and axial X-rays. Bohler's an
gle increased on average from 11 to 26 degrees (P < 0.001) postoperatively,
but decreased (9-8<degrees>) in the conservative group. The posterior face
t residual displacement was 1.1 and 4.7 nim, respectively. O'Farrell (12 pa
tients/12 controls) showed 8 out of 12 had Bohler's and Gissane's angle par
tially or fully restored postoperatively, and not conservatively. Parmar (2
5 patients/31 controls) used preoperative lateral radiographs, but failed w
ith CT to grade the postoperative reduction, whilst the conservative group
was unaltered. There was no systematic, blinded assessment of the change in
radiology by the operative intervention. Overall there was weak evidence t
o support ORIF.
In conclusion, there are only three randomised, controlled studies involvin
g small numbers of patients, which showed improved plain radiographic anato
mical alignment, in the postoperative but not conservative group. Further p
rospective randomised, controlled trials with independent and blinded asses
sment with accurate CT and clinical evaluation will be required before ORIF
can be adopted as the best practice. (C) 2001 Elsevier Science Ltd. All ri
ghts reserved.