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. 2009 Feb;33(1):19-26.
doi: 10.1007/s00264-007-0443-5. Epub 2007 Sep 1.

The role of plating in the operative treatment of severe open tibial fractures: a systematic review

Peter V Giannoudis  1 , Costas Papakostidis, George Kouvidis, Nikolaos K Kanakaris
Affiliations

The role of plating in the operative treatment of severe open tibial fractures: a systematic review

Peter V Giannoudis et al. Int Orthop. 2009 Feb.

Abstract
in English, French

Open fractures of the tibial diaphysis are the result of high-energy trauma. They are usually associated with extensive soft tissue loss and represent serious clinical problems. Surgical treatment of these injuries has been associated with substantial complications such as osteomyelitis, delayed bone healing, poor functional outcome, soft-tissue failure, or even amputations. More recently a staged treatment, with initial application of spanning external fixators followed by definitive fixation at secondary phase, has been advocated. Plating of these fractures in the acute setting remains a topic of heated discussion. A systematic review of the literature was carried out in order to investigate the existing evidence concerning the efficacy and safety of this method of osteosynthesis. Eleven papers met the inclusion criteria, accumulating 492 open tibial fractures treated with plating. The overall union rate ranged from 62-95% across all studies, with time to union ranging from 13-42 weeks. The reoperation rate ranged from 8-69% and a pooled estimate of deep infection rate was calculated at 11%. Plate fixation for the treatment of open tibial fractures can be considered under specific conditions which need to be elicited and clarified with future well-designed and conducted clinical trials.

Les fractures ouvertes de la diaphyse tibiale sont généralement secondaires à un traumatisme violent. Elles sont généralement associées avec des lésions ou des pertes de substance des tissus mous. Ceci entraîne de sérieux problèmes thérapeutiques. Le traitement chirurgical de ces traumatismes est émaillé de sérieuses complications: infections, retards de consolidation, problèmes fonctionnels, lésions persistantes des tissus mous, ces complications pouvant parfois conduire à une amputation. Récemment, un traitement en deux étapes a été mis au point avec mise en place initiale d’un fixateur externe, suivi secondairement par une fixation définitive. L’ostéosynthèse par plaques de ces fractures, en période aigue reste un domaine très discuté. Une revue systématique de la littérature nous a permis d’évaluer les résultats de cette méthode d’ostéosynthèse. 11 articles regroupant 492 fractures ouvertes traitées par plaque ont pu être recensés. Le taux de consolidation varie de 62 à 95% avec un temps de consolidation de 13 à 42 semaines. Le taux de réintervation varie également de 8 à 69% et le taux d’infection profonde peut être estimé à 11%. L’ostéosynthèse par plaque dans le traitement des fractures ouvertes peut être considérée, sous certaines conditions, comme un traitement dont les résultats peuvent être parfaitement définis ceci nécessitant également quelques études ultérieures.

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Figures

Fig. 1
Fig. 1
Study quality improvement, as indicated by the linear regression analysis
Fig. 2
Fig. 2
Range of union rate across all studies
Fig. 3
Fig. 3
Range of infection rate
Fig. 4
Fig. 4
Range of reoperation rate
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