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

• Published in: Injury 2020-07, Vol.51 (7), p.1448-1456
• Main Authors: Malik-Tabassum, Khalid, Pillai, Kavya, Hussain, Yusuf, Bleibleh, Sabri, Babu, Satish, Giannoudis, Peter V., Tosounidis, Theodoros H.
• Format: Article
• Language: English
• Subjects: Circular frame; External Fixators; Fine-wire fixator; Fracture Fixation, Internal; Fracture Healing; Functional outcomes; Humans; Intra-articular distal tibia; Intra-Articular Fractures - surgery; Open Fracture Reduction; Orif; Physical Functional Performance; Pilon; Postoperative Complications; Tibial Fractures - surgery
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2020.04.056

•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. 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. 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. 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. 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.