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. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Malik-Tabassum, Khalid; Pillai, Kavya; Hussain, Yusuf; Bleibleh, Sabri; Babu, Satish; Giannoudis, Peter V.; Tosounidis, Theodoros H.
• Is Part Of: Injury. Volume 51:Issue 7(2020)
• Page Start: 1448
• Page End: 1456
• Publication Date: 2020-07
• Subjects: Circular frame -- Fine-wire fixator -- Functional outcomes -- Intra-articular distal tibia -- Orif -- Pilon; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.04.056
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Both ORIF and CEF in tibial plafond fractures resulted in similar rates of non-union, malunion, infections, and secondary arthrodesis. ORIF resulted in lower rates of post-traumatic arthritis but higher rates of unplanned metalwork removal when compared to CEF. Post-operative functional outcomes in patients treated with either fixation method were similar. 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.