A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures

Abstract

Aim: This article aims to compare the outcomes between open reduction and internal fixation (ORIF) and external fixation (ExFix) in tibial plateau fractures.

Background: Open reduction and internal fixation and external fixation are common methods for managing tibial plateau fractures without a consensus of choice.

Materials and methods: PubMed, Cochrane Library, Ovid, CINAHL®, Scopus, and Embase were searched. Clinical studies in humans comparing ExFix and ORIF for tibial plateau fractures were included. Case reports, pathological, and biomechanical studies were excluded. Two investigators reviewed the studies independently, and any discrepancies were resolved. The quality and heterogeneity of each study were assessed in addition to calculating the odds ratio (OR) of the surgical outcomes and complications at a 95% confidence interval, with p <0.05 as statistical significance.

Results: Of the 14 included studies, one was a randomised trial, one was a prospective study, and 12 were retrospective studies. The 865 fractures identified across the studies constituted 458 (52.9%) in the ExFix group and 407 (47.1%) in the ORIF group. Most studies indicated a better outcome for ORIF as compared to ExFix. Open reduction and internal fixation had a lower incidence of superficial infection and postoperative osteoarthritis, while ExFix revealed a lower proportion with heterotopic ossification (HTO).

Conclusion: ExFix has a higher rate of superficial infections and osteoarthritis, whereas ORIF has a higher incidence of HTO. Larger studies are needed to compare outcomes and investigate the findings of this study further.

Clinical significance: This up-to-date meta-analysis on tibial plateau management will help surgeons make evidence-based decisions regarding the use of ORIF versus ExFix.

How to cite this article: Naja AS, Bouji N, Eddine MN, et al. A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures. Strategies Trauma Limb Reconstr 2022;17(2):105-116.

Keywords: External fixator; Fracture; Internal fracture fixation; Tibia.

Flowchart 1

PRISMA flow diagram showing the study selection process

Fig. 2

Malunion and non-union odds ratios

Fig. 3

Postop osteoarthritis (PTOA) odds ratios

Fig. 4

The odds ratios of reoperation and total knee replacements (TKR)

Fig. 5

Superficial and deep infection odds ratios

Fig. 6

The odds ratios of postoperative deep vein thromboembolism and compartment syndrome

Fig. 7

Heterotopic ossifications odds ratio

Fig. 8

The odds ratios of function parameters: Knee stiffness, extension deficit of ≥10°, and flexion <90°