Post-operative outcomes of open reduction and internal fixation versus circular external fixation in treatment of tibial plafond fractures: a systematic review and meta-analysis.

No Thumbnail Available
Authors
Bleibleh, Sabri
Issue Date
2020-07-01
Journal
Type
Article
Peer-Reviewed Publication
Keywords
Circular frame
Comparative Study
Exterior fixators
Fine-wire fixator
Fracture fixation
Fractures
Functional outcomes
Internal-articular fractures
Intra-articular distal tibia
Meta-analysis
Open fracture reduction
ORIF
Patient outcomes
Physical activity
Peer-reviewed article
Physical functional performance
Pilon
Postoperative complications
Systematic review
Tibial fractures
Tibial plafond fractures (TPF)
Journal Title
Injury: International Journal of the Care of the Injured
Volume
51
Issue
7
Begin page
1448
End page
1456
Abstract
Introduction: Tibial plafond fractures (TPF) are complex injuries often resulting in poor outcomes. Combination of articular impaction, metaphysealcomminution and soft-tissue injury results in a significant treatment challenge. The aim of this study was to conduct a systematic review and meta-analysis to compare post-operative complications and functional outcomes of open reduction and internal fixation (ORIF) versus circular external fixation (CEF) for treatment of TPF. Methods: A comprehensive search of PubMed/MEDLINE, Embase, Scopus and Cochrane library was undertaken. All studies published in English language comparing ORIF with CEF for treatment of TPF were included. Results: 5 comparative studies with 239 fractures met the inclusion criteria. Meta-analysis showed no significant difference in rates of non-union, malunion, superficial infection, deep infection, and secondary arthrodesis between the two treatment groups. Significantly higher rate of unplanned metalwork removal (RR 5.68, 95% CI 1.13 to 28.55, p = 0.04) and lower rate of post-traumatic arthritis (RR 0.48, 95% CI 0.30 to 0.78, p = 0.003) were found in patients that underwent ORIF. 1 study showed significantly lower functional outcomes scores with CEF (p< 0.05), whereas 3 studies found comparable functional outcomes between the two treatment groups. Overall, there was a preference in treating more severe injuries with CEF. Conclusion: CEF and ORIF are both acceptable treatment options for surgical management of TPF, with comparable post-operative complication rates and functional outcomes. This study highlights paucity of high-quality evidence regarding the optimal fixation method for TPF.
Citation
Malik-Tabassum K, Pillai K, Hussain Y, Bleibleh S, Babu S, Giannoudis PV, Tosounidis TH. Post-operative outcomes of open reduction and internal fixation versus circular external fixation in treatment of tibial plafond fractures: A systematic review and meta-analysis. Injury. 2020 Jul;51(7):1448-1456. doi: 10.1016/j.injury.2020.04.056. Epub 2020 May 12. PMID: 32430194.