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

Superiority of minimally invasive surgical approaches for displaced intra-articular calcaneal fractures (DIACF) remains debated. This review aimed to compare surgical outcomes between two approaches: closed percutaneous reduction (PR) and mini-open sinus tarsi approach (STA).

A systematic search identified studies comparing PR vs. STA for acute traumatic DIACFs. Complication rates, operative parameters, functional and radiological outcomes were extracted and analysed.

837 patients were included from eight eligible studies, with Sanders type II and III fractures. PR demonstrated a 53% risk reduction in overall complication rate vs. STA (RR 0.47, 95% CI [0.27-0.83], p = 0.009), including wound complications. AOFAS scores marginally favoured PR vs. STA (MD 0.82 points, p = 0.034), with this difference having doubtful clinical relevance. Radiological parameters were comparable, although calcaneal width remained wider with PR. PR was also associated with shorter times to surgery, length of stays and intra-operative times, although with high heterogeneity in the pooled outcome estimates.