External fixation versus open reduction and internal fixation for tibial pilon fractures: A meta-analysis based on observational studies

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• 作者：Yi-Chen Meng ; Xu-Hui Zhou ; ^{myc910429@163.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Fractures ; bone ; Fracture fixation ; internal ; External fixation ; Meta-analysis
• 刊名：Chinese Journal of Traumatology (English Edition)
• 出版年：2016
• 出版时间：13 October 2016
• 年：2016
• 卷：19
• 期：5
• 页码：278-282
• 全文大小：814 K

文摘

Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications.

Methods

A computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference (WMD), risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for estimating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2.

Results

Ten cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection (p = 0.13), reduction (p = 0.11), clinical evaluation (p = 0.82), post-traumatic arthrosis (p = 0.87), and union time (p = 0.35). Besides, ExFix group was found to have a higher rate of superficial infection (p = 0.001), malunion (p = 0.01) and nonunion (p = 0.02), but have a lower risk of unplanned hardware removal (p = 0.0002).

Conclusions

We suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, but a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation, post-traumatic arthrosis and union time.