Two-stage Open Reduction and Internal Fixation Versus Limited Internal Fixation Combined with External Fixation: a Meta-analysis of Postoperative Complications in Patients with Severe Pilon Fractures

Overview

Journal J Int Med Res

Publisher Sage Publications

Specialty General Medicine

Date 2018 Jun 20

PMID 29916291

Citations 9

Authors

Xueliang Cui

Hui Chen

Yunfeng Rui

Yang Niu

He Li

Affiliations

Soon will be listed here.

Abstract

Objectives Two-stage open reduction and internal fixation (ORIF) and limited internal fixation combined with external fixation (LIFEF) are two widely used methods to treat Pilon injury. However, which method is superior to the other remains controversial. This meta-analysis was performed to quantitatively compare two-stage ORIF and LIFEF and clarify which method is better with respect to postoperative complications in the treatment of tibial Pilon fractures. Methods We conducted a meta-analysis to quantitatively compare the postoperative complications between two-stage ORIF and LIFEF. Eight studies involving 360 fractures in 359 patients were included in the meta-analysis. Results The two-stage ORIF group had a significantly lower risk of superficial infection, nonunion, and bone healing problems than the LIFEF group. However, no significant differences in deep infection, delayed union, malunion, arthritis symptoms, or chronic osteomyelitis were found between the two groups. Conclusion Two-stage ORIF was associated with a lower risk of postoperative complications with respect to superficial infection, nonunion, and bone healing problems than LIFEF for tibial Pilon fractures. Level of evidence 2.

Citing Articles

Predictors for infection severity for open tibial fractures: major trauma centre perspective.

Zhang J, Lu V, Zhou A, Stevenson A, Thahir A, Krkovic M Arch Orthop Trauma Surg. 2023; 143(11):6579-6587.

PMID: 37418004 PMC: 10541339. DOI: 10.1007/s00402-023-04956-1.

Early Reduction of the Posterior Column: A Surgical Technique in AO/OTA C3 Tibial Pilon Fractures.

Gao Y, Zhu H, Guo Y, Yu X J Pers Med. 2023; 13(3).

PMID: 36983732 PMC: 10051139. DOI: 10.3390/jpm13030551.

Plate fixation versus percutaneous rush pinning for osteosynthesis of the fibula in pilon fractures. A retrospective comparative study.

Poutoglidou F, Metaxiotis D, Vasiliadis A, Mpeletsiotis A Hippokratia. 2022; 25(2):63-68.

PMID: 35937519 PMC: 9347338.

Application of one-third tubular steel plates and screws for fixation of medial column in pilon fractures.

Wang Z, Zhang J, He J, Gao H, Chen P, Zhou Y Ann Transl Med. 2022; 10(9):518.

PMID: 35928750 PMC: 9347046. DOI: 10.21037/atm-22-92.

Ankle joint salvage and reconstruction by limited ORIF combined with an Ilizarov external fixator for complex open tibial pilon fractures (AO 43-C3.3) with segmental bone defects.

Chen Y, Li Y, Ouyang X, Zhang H BMC Musculoskelet Disord. 2022; 23(1):97.

PMID: 35090407 PMC: 8800251. DOI: 10.1186/s12891-022-05060-y.

References

Blauth M, Bastian L, Krettek C, Knop C, Evans S . Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001; 15(3):153-60. DOI: 10.1097/00005131-200103000-00002. View

RUEDI T, ALLGOWER M . The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Relat Res. 1979; (138):105-10. View

Richards J, Magill M, Tressler M, Shuler F, Kregor P, Obremskey W . External fixation versus ORIF for distal intra-articular tibia fractures. Orthopedics. 2012; 35(6):e862-7. DOI: 10.3928/01477447-20120525-25. View

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009; 62(10):1006-12. DOI: 10.1016/j.jclinepi.2009.06.005. View

Hill C . Does external fixation result in superior ankle function than open reduction internal fixation in the management of adult distal tibial plafond fractures?. Foot Ankle Surg. 2016; 22(3):146-151. DOI: 10.1016/j.fas.2015.07.002. View

Egol K, Tejwani N, Capla E, Wolinsky P, Koval K . Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma. 2005; 19(7):448-55. DOI: 10.1097/01.bot.0000171881.11205.80. View

Ketz J, Sanders R . Staged posterior tibial plating for the treatment of Orthopaedic Trauma Association 43C2 and 43C3 tibial pilon fractures. J Orthop Trauma. 2011; 26(6):341-7. DOI: 10.1097/BOT.0b013e318225881a. View

Zhang S, Zhang Y, Wang S, Zhang H, Liu P, Zhang W . Clinical efficacy and safety of limited internal fixation combined with external fixation for Pilon fracture: A systematic review and meta-analysis. Chin J Traumatol. 2017; 20(2):94-98. PMC: 5392718. DOI: 10.1016/j.cjtee.2016.06.012. View

Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D . Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications. Acta Orthop Belg. 2011; 77(4):432-40. View

10.

Deivaraju C, Vlasak R, Sadasivan K . Staged treatment of pilon fractures. J Orthop. 2016; 12(Suppl 1):S1-6. PMC: 4674545. DOI: 10.1016/j.jor.2015.01.028. View

11.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

12.

Liporace F, Yoon R . Decisions and staging leading to definitive open management of pilon fractures: where have we come from and where are we now?. J Orthop Trauma. 2012; 26(8):488-98. DOI: 10.1097/BOT.0b013e31822fbdbe. View

13.

Sirkin M, Sanders R, DiPasquale T, Herscovici Jr D . A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 2004; 18(8 Suppl):S32-8. DOI: 10.1097/00005131-200409001-00005. View

14.

Wang C, Li Y, Huang L, Wang M . Comparison of two-staged ORIF and limited internal fixation with external fixator for closed tibial plafond fractures. Arch Orthop Trauma Surg. 2010; 130(10):1289-97. DOI: 10.1007/s00402-010-1075-6. View

15.

Cisneros L, Gomez M, Alvarez C, Millan A, de Caso J, Soria L . Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation. Indian J Orthop. 2016; 50(2):123-30. PMC: 4800953. DOI: 10.4103/0019-5413.177577. View

16.

Tarkin I, Clare M, Marcantonio A, Pape H . An update on the management of high-energy pilon fractures. Injury. 2007; 39(2):142-54. DOI: 10.1016/j.injury.2007.07.024. View

17.

Penny P, Swords M, Heisler J, Cien A, Sands A, Cole P . Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: Is dual plate fixation necessary?. Injury. 2016; 47(8):1761-9. DOI: 10.1016/j.injury.2016.05.026. View

18.

Abou Elatta M, Assal F, Basheer H, El Morshidy A, Elglaind S, Abdalla M . The use of dynamic external fixation in the treatment of dorsal fracture subluxations and pilon fractures of finger proximal interphalangeal joints. J Hand Surg Eur Vol. 2016; 42(2):182-187. DOI: 10.1177/1753193416674155. View

19.

Davidovitch R, Elkhechen R, Elkataran R, Romo S, Walsh M, Egol K . Open reduction with internal fixation versus limited internal fixation and external fixation for high grade pilon fractures (OTA type 43C). Foot Ankle Int. 2012; 32(10):955-61. DOI: 10.3113/FAI.2011.0955. View

20.

Busel G, Watson J, Israel H . Evaluation of Fibular Fracture Type vs Location of Tibial Fixation of Pilon Fractures. Foot Ankle Int. 2017; 38(6):650-655. DOI: 10.1177/1071100717695348. View