Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence?

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Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence? / Bernasconi, Alessio; Iorio, Paolino; Ghani, Yaser; Argyropoulos, Miltiadis; Patel, Shelain; Barg, Alexej; Smeraglia, Francesco; Balato, Giovanni; Welck, Matthew.

In: ARCH ORTHOP TRAUM SU, Vol. 142, No. 8, 08.2022, p. 1911-1922.

Research output: SCORING: Contribution to journalSCORING: Review articleResearch

Harvard

Bernasconi, A, Iorio, P, Ghani, Y, Argyropoulos, M, Patel, S, Barg, A, Smeraglia, F, Balato, G & Welck, M 2022, 'Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence?', ARCH ORTHOP TRAUM SU, vol. 142, no. 8, pp. 1911-1922. https://doi.org/10.1007/s00402-021-03944-7

APA

Bernasconi, A., Iorio, P., Ghani, Y., Argyropoulos, M., Patel, S., Barg, A., Smeraglia, F., Balato, G., & Welck, M. (2022). Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence? ARCH ORTHOP TRAUM SU, 142(8), 1911-1922. https://doi.org/10.1007/s00402-021-03944-7

Vancouver

Bibtex

@article{3aa986b29ae5409a8d43e394851aeef1,
title = "Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence?",
abstract = "INTRODUCTION: Intramedullary locking devices (ILDs) have recently been advocated as a minimally invasive approach to manage displaced intraarticular calcaneal fractures (DIACFs), to minimise complications and improve outcomes. We reviewed clinical and biomechanical studies dealing with commercially available devices to identify their characteristics, efficacy and safety.METHODS: Following a PRISMA checklist, Medline, Scopus and EMBASE databases were searched to identify studies reporting the use of ILDs for treating DIACFs. Biomechanical studies were first evaluated. Cohort studies were then reviewed for demographics, surgical technique, postoperative protocol, clinical and radiographic scores, complications and reoperations. The modified Coleman Methodology Score (CMS) was used to assess the quality of studies.RESULTS: Eleven studies were identified which investigated two devices (Calcanail{\textregistered}, C-Nail{\textregistered}). Three biomechanical studies proved they offered adequate primary stability, stiffness, interfragmentary motion and load to failure. Eight clinical studies (321 feet, 308 patients) demonstrated a positive clinical and radiographic outcome at 16-months average follow-up. Metalware irritation (up to 20%) and temporary nerve entrapment symptoms (up to 30%) were the most common complications, while soft tissue issues (wound necrosis, delayed healing, infection) were reported in 3-5% of cases. Conversion to subtalar fusion was necessary in up to 6% of cases. Four (50%) out of 8 studies were authored by implant designers and in 5 (62%) relevant conflicts of interest were disclosed. Mean (± standard deviation) CMS was 59 ± 9.8, indicating moderate quality.CONCLUSIONS: Treating DIAFCs with ILDs leads to satisfactory clinical outcomes at short-term follow-up, enabling restoration of calcaneal height and improved subtalar joint congruency. Metalware irritation and temporary nerve entrapment symptoms are common complications although wound complications are less frequent than after open lateral approaches. The quality of evidence provided so far is moderate and potentially biased by the conflict of interest, raising concerns about the generalisability of results.LEVEL OF EVIDENCE: Level V - Review of Level III to V studies.",
author = "Alessio Bernasconi and Paolino Iorio and Yaser Ghani and Miltiadis Argyropoulos and Shelain Patel and Alexej Barg and Francesco Smeraglia and Giovanni Balato and Matthew Welck",
year = "2022",
month = aug,
doi = "10.1007/s00402-021-03944-7",
language = "English",
volume = "142",
pages = "1911--1922",
journal = "ARCH ORTHOP TRAUM SU",
issn = "0936-8051",
publisher = "Springer",
number = "8",

}

RIS

TY - JOUR

T1 - Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence?

AU - Bernasconi, Alessio

AU - Iorio, Paolino

AU - Ghani, Yaser

AU - Argyropoulos, Miltiadis

AU - Patel, Shelain

AU - Barg, Alexej

AU - Smeraglia, Francesco

AU - Balato, Giovanni

AU - Welck, Matthew

PY - 2022/8

Y1 - 2022/8

N2 - INTRODUCTION: Intramedullary locking devices (ILDs) have recently been advocated as a minimally invasive approach to manage displaced intraarticular calcaneal fractures (DIACFs), to minimise complications and improve outcomes. We reviewed clinical and biomechanical studies dealing with commercially available devices to identify their characteristics, efficacy and safety.METHODS: Following a PRISMA checklist, Medline, Scopus and EMBASE databases were searched to identify studies reporting the use of ILDs for treating DIACFs. Biomechanical studies were first evaluated. Cohort studies were then reviewed for demographics, surgical technique, postoperative protocol, clinical and radiographic scores, complications and reoperations. The modified Coleman Methodology Score (CMS) was used to assess the quality of studies.RESULTS: Eleven studies were identified which investigated two devices (Calcanail®, C-Nail®). Three biomechanical studies proved they offered adequate primary stability, stiffness, interfragmentary motion and load to failure. Eight clinical studies (321 feet, 308 patients) demonstrated a positive clinical and radiographic outcome at 16-months average follow-up. Metalware irritation (up to 20%) and temporary nerve entrapment symptoms (up to 30%) were the most common complications, while soft tissue issues (wound necrosis, delayed healing, infection) were reported in 3-5% of cases. Conversion to subtalar fusion was necessary in up to 6% of cases. Four (50%) out of 8 studies were authored by implant designers and in 5 (62%) relevant conflicts of interest were disclosed. Mean (± standard deviation) CMS was 59 ± 9.8, indicating moderate quality.CONCLUSIONS: Treating DIAFCs with ILDs leads to satisfactory clinical outcomes at short-term follow-up, enabling restoration of calcaneal height and improved subtalar joint congruency. Metalware irritation and temporary nerve entrapment symptoms are common complications although wound complications are less frequent than after open lateral approaches. The quality of evidence provided so far is moderate and potentially biased by the conflict of interest, raising concerns about the generalisability of results.LEVEL OF EVIDENCE: Level V - Review of Level III to V studies.

AB - INTRODUCTION: Intramedullary locking devices (ILDs) have recently been advocated as a minimally invasive approach to manage displaced intraarticular calcaneal fractures (DIACFs), to minimise complications and improve outcomes. We reviewed clinical and biomechanical studies dealing with commercially available devices to identify their characteristics, efficacy and safety.METHODS: Following a PRISMA checklist, Medline, Scopus and EMBASE databases were searched to identify studies reporting the use of ILDs for treating DIACFs. Biomechanical studies were first evaluated. Cohort studies were then reviewed for demographics, surgical technique, postoperative protocol, clinical and radiographic scores, complications and reoperations. The modified Coleman Methodology Score (CMS) was used to assess the quality of studies.RESULTS: Eleven studies were identified which investigated two devices (Calcanail®, C-Nail®). Three biomechanical studies proved they offered adequate primary stability, stiffness, interfragmentary motion and load to failure. Eight clinical studies (321 feet, 308 patients) demonstrated a positive clinical and radiographic outcome at 16-months average follow-up. Metalware irritation (up to 20%) and temporary nerve entrapment symptoms (up to 30%) were the most common complications, while soft tissue issues (wound necrosis, delayed healing, infection) were reported in 3-5% of cases. Conversion to subtalar fusion was necessary in up to 6% of cases. Four (50%) out of 8 studies were authored by implant designers and in 5 (62%) relevant conflicts of interest were disclosed. Mean (± standard deviation) CMS was 59 ± 9.8, indicating moderate quality.CONCLUSIONS: Treating DIAFCs with ILDs leads to satisfactory clinical outcomes at short-term follow-up, enabling restoration of calcaneal height and improved subtalar joint congruency. Metalware irritation and temporary nerve entrapment symptoms are common complications although wound complications are less frequent than after open lateral approaches. The quality of evidence provided so far is moderate and potentially biased by the conflict of interest, raising concerns about the generalisability of results.LEVEL OF EVIDENCE: Level V - Review of Level III to V studies.

U2 - 10.1007/s00402-021-03944-7

DO - 10.1007/s00402-021-03944-7

M3 - SCORING: Review article

C2 - 33977313

VL - 142

SP - 1911

EP - 1922

JO - ARCH ORTHOP TRAUM SU

JF - ARCH ORTHOP TRAUM SU

SN - 0936-8051

IS - 8

ER -