Open reduction and internal fixation versus circular external fixation for tibial plateau fractures: a meta-analysis

doi:10.12307/2022.079

Abstract

Abstract: OBJECTIVE: Tibial plateau fractures are more prone to postoperative complications and adverse reactions. At present, the most commonly used surgical methods for the treatment of tibial plateau fractures are open reduction with internal fixation and circular external fixators. There are few comparative studies on the prognosis of the two surgical methods. There are many controversies about the choice of surgical method. This article evaluates the clinical efficacy of open reduction internal fixation and circular external fixation for tibial plateau fractures through meta-analysis.
METHODS: From 2005 to 2020, PubMed, EMbase, Cochrane Library, Wanfang, CNKI, and VIP databases related to open reduction and internal fixation and circular external fixation in the treatment of tibial plateau fractures were searched by computer for clinical randomized controlled trials and retrospective cohort studies. After reading and screening the literature, in turn, the retrospective cohort studies that met the screening requirements were evaluated using the Newcastle-Ottawa Scale. The risk of bias in the randomized controlled trials was evaluated using the Cochrane Handbook standard. RevMan 5.3 software was used to conduct meta-analysis of the data.
RESULTS: (1) A total of 11 articles were included. Among them, 374 patients used open reduction and internal fixation; 316 patients used circular external fixation. Two randomized controlled case trials mentioned random methods. Nine retrospective cohort studies evaluated the literature quality according to the Newcastle-Ottawa Scale, including 3 articles with 8 points, 5 articles with 7 points, 1 article with 6 points; the quality of the literature was good, and the data had good authenticity and reliability. (2) The results of meta-analysis showed that the range of motion (MD=-4.83, 95%CI:-7.01 to -2.65, P < 0.000 1) and postoperative infection rate (OR=0.22, 95%CI:0.13-0.40, P < 0.000 01) in the open reduction and internal fixation group were better than those in the circular external fixation group. The length of hospital stay in the circular external fixation group was better than that in the open reduction and internal fixation group (MD=8.01, 95%CI:7.05-8.96, P < 0.000 01). (3) There was no significant difference in poor postoperative healing, postoperative osteoarthritis, postoperative knee varus, and RSS score between open reduction and internal fixation group and circular external fixation group (P > 0.05).
CONCLUSION: in the treatment of tibial plateau fractures, compared with the circular external fixation, the open reduction and internal fixation has a lower risk of postoperative infection and better postoperative range of motion, but patients repaired by the circular external fixation have a shorter hospital stay.

Key words: fractures, tibial fractures, tibial plateau, internal fixation, open reduction and internal fixation, external fixation, meta-analysis, circular external fixation

CLC Number:

Yang Ruijia, Jiang Lingkai, Dong Zhengquan, Wang Yunfei, Ma Zhou, Cong Linlin, Guo Yanjing, Gao Yangyang, Li Pengcui. Open reduction and internal fixation versus circular external fixation for tibial plateau fractures: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(3): 480-486.

Figures/Tables 12

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