Khalid Malik-Tabassum1, Kavya Pillai2, Yusuf Hussain3, Sabri Bleibleh4, Satish Babu5, Peter V Giannoudis6, Theodoros H Tosounidis7. 1. Trauma & Orthopaedics, Conquest Hospital, East Sussex NHS Healthcare Trust, The Ridge, Hastings TN37 7RD, United Kingdom. Electronic address: khalid.malik-tabassum@nhs.net. 2. North Middlesex University Hospital, London N18 1QX, United Kingdom. Electronic address: kavya.pillai@nhs.net. 3. Bradford Royal Infirmary, Bradford BD9 6RJ, United Kingdom. Electronic address: yusufhussain@doctors.org.uk. 4. Trauma & Orthopaedics, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom. 5. Trauma & Orthopaedics, Frimley Park Hospital, Frimley GU16 7UJ, United Kingdom. Electronic address: sbabu@doctors.org.uk. 6. Orthopaedic Surgery, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom. Electronic address: p.giannoudis@leeds.ac.uk. 7. Orthopaedic Surgery, University of Crete School of Medicine, Heraklion, Greece. Electronic address: ttosounidis@yahoo.com.
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.
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.