Screw fixation versus plate fixation for posterior malleolus fracture: a meta-analysis

doi:10.3969/j.issn.2095-4344.0361

Abstract

Abstract:

BACKGROUND: It is still controversial about which is the best internal fixation method for posterior malleolus fracture. Some scholars believe that plate fixation shows satisfactory efficacy than screw fixation. But other scholars insist screw fixation for posterior malleolus fracture.

OBJECTIVE: To compare the efficacy and safety of posterior malleolus fracture with screw fixation and plate fixation through a meta-analysis.

METHODS: A computer-based online search was conducted in Medline, Embase, PubMed, Embase, CNKI, VIP and WanFang databases by using the keywords of “posterior malleolus AND fracture AND Screw AND Plate AND RCT OR quasi-RCT OR CCT” in English and Chinese, respectively to screen the relevant literature published from January 1995 to December 2017. A meta-analysis was performed using Revman 5.3 software provided by Cochrane Collaboration.

RESULTS AND CONCLUSION: (1) Nine trials were included. (2) The meta-analysis results showed that there were no significant differences in the American Orthopaedic Foot & Ankle Society scores (OR=-2.23, 95%CI (-4.95, 0.94), P=0.11) and the incidence of arthritis (OR=0.11, 95%CI (-0.06, 0.28), P=0.21) between two groups at 12 months postoperatively. (3) The fracture healing time (OR=0.36, 95%CI (0.14, 0.58), P=0.001) and malreduction (OR=0.07, 95%CI (0.03, 0.11), P=0.000 3) in plate fixation were superior to screw fixation. (4) The operation time (OR=-14.97, 95%CI (-29.09, -0.84), P=0.04), and intraoperative blood loss (OR=-0.52, 95%CI (-0.84, -0.20), P=0.001) in screw fixation were less than those in plate fixation. (5) These results show that plate fixation exhibits superiority in the fracture healing time and the incidence of malreduction in the treatment of posterior malleolus fracture. The screw fixation is minimally invasive. Because part of the literature is not high-quality randomized controlled trails, bias may exist, and more high-quality randomized controlled trials are required.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Ankle Joint, Fractures, Bone, Bone Nails, Internal Fixators, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Chai Hao, Wu Ting, Shu Li, Zhang Lei. Screw fixation versus plate fixation for posterior malleolus fracture: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(27): 4423-4428.

Figures/Tables 3

2.2 纳入研究的方法学质量各纳入研究的方法学质量详见表2。 2.3 Meta分析结果 2.3.1 手术时间有4个研究比较了手术时间[11-13，15]，其中螺钉组198例，钢板组196例。异质性检验结果表明，各研究间异质性明显(I2=94%)，采用随机效应模型进行合并分析，Meta分析结果显示，2种手术时间差异有显著性意义[OR=-14.97，95%CI(-29.09，-0.84)，P=0.04]，螺钉组手术时间少于钢板组(图2)。 2.3.2 术中出血有2个研究报道了术中出血情况[13，15]，其中螺钉组72例，钢板组84例。各研究之间同质性好(I2=0%)，采用固定效应模型进行合并分析，Meta分析结果显示，2种手术术中出血差异有显著性意义[OR=-0.52，95%CI(-0.84，-0.20)，P=0.001]，螺钉组术中出血少于钢板组(图3)。 2.3.3 术后12个月AOFAS评分有6个研究报道了术后12个月AOFAS评分情况[9-11，14-15，17]，其中螺钉组218例，钢板组211例。异质性检验结果表明，各研究间异质性明显(I2=84%)，采用随机效应模型进行合并分析，Meta分析结果显示，2种手术术后12个月AOFAS评分差异无显著性意义[OR=-2.23，95%CI(-4.95，0.94)，P=0.11] (图4)。 2.3.4 骨折愈合时间有5个研究报道了骨折愈合时间情况[9-10，12-14]，其中螺钉组172例，钢板组165例。各研究之间同质性好(I2=45%)，采用固定效应模型进行合并分析，Meta分析结果显示，2种手术骨折愈合时间差异有显著性意义[OR=0.36，95%CI(0.14，0.58)，P=0.001]，螺钉组骨折愈合时间长于钢板组(图5)。 2.3.5 骨折复位不良有8个研究报道了术后复位不良情况[10-17]，其中螺钉组291例，钢板组288例。各研究之间同质性好(I2=0%)，采用固定效应模型进行合并分析，Meta分析结果显示，2种手术术后复位不良情况差异有显著性意义[OR=0.07，95%CI(0.03，0.11)，P=0.000 3]，螺钉组复位不良数多于钢板组(图6)。"

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