DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20205854

Treatment of choice for bicondylar tibial plateau fractures between open reduction with internal fixation versus hybrid circular external fixator: a systematic review

I. Made Arya Susila, Sherly Desnita Savio, Cokorda Gde Oka Dharmayuda

Abstract


The high complication rate is closely related to the incidence of bicondylar tibial plateau fractures (BTPF) due to the involvement of the articular surface. The aim of this study is to compare open reduction with internal fixation (ORIF) and hybrid circular external fixation (HCEF) as the choice of surgical procedure for BTPF because these two procedures is still controversial until now. A systematic review using Cochrane library, PubMed, and Google Scholar was conducted based on PRISMA guideline. Inclusion criteria were studies comparing HCEF and ORIF of BTPF. Studies of only one surgical technique modality, schatzker types I-IV tibial plateau fractures, and case reports were excluded, resulting in six included studies. There is no significant difference in radiographs, functional and anatomical outcomes in both group (ORIF vs HCEF). Complications that measured are higher infection rate found in the ORIF group. Blood loss was higher in the ORIF group, while both procedures have similar operation time and functional outcome. The mean of hospital length of stay (LoS) seems to be higher 6.83 days (95%CI 0.96-12.70; P<0.00001) on ORIF group from the random effect of forest plot evaluation. According to this study, HCEF is more beneficial in terms of blood loss and hospital LoS. But overall ORIF and HCEF carry similar operation time, functional outcome, union rate, and complication.


Keywords


Open reduction internal fixation, Hybrid circular external fixation, Bicondylar tibial plateau fracture

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References


Conserva V, Vicenti G, Allegretti G, Filipponi M, Monno A, Picca G, et al. Retrospective review of tibial plateau fractures treated by two methods without staging. Injury. Epub ahead of print. 2015.

Ahearn N, Oppy A, Halliday R, Rowett-Harris J, Morris SA, Chesser TJ, et al. The outcome following fixation of bicondylar tibial plateau fractures. Bone Jt J. Epub ahead of print. 2014.

Ali F. No Title. Treat Outcomes Bicondylar Tibial Plateau Fract by Hybrid Fixator with open Reduct Intern Fixat. 2017;13:28-31.

Bertrand ML, Pascual-López FJ, Guerado E. Severe tibial plateau fractures (Schatzker V–VI): open reduction and internal fixation versus hybrid external fixation. Injury. Epub Ahead Print. 2017.

Bove F, Sala F, Capitani P, Thabet AM, Scita V, Spagnolo R. Treatment of fractures of the tibial plateau (Schatzker VI) with external fixators versus plate osteosynthesis. Injury. 2018:3:12-8.

Swiontkowski MF. Open Reduction and Internal Fixation Compared with Circular Fixator Application for Bicondylar Tibial Plateau Fractures: Results of a Multicenter, Prospective, Randomized Clinical Trial. Yearb Orthop 2008;2008:53-5.

Zhao X, Ma J, Ma X long, Jiang X, Wang Y, Li F, et al. A meta-analysis of external fixation versus open reduction and internal fixation for complex tibial plateau fractures. International Journal of Surgery. Epub Ahead Print. 2017.

Ali AM. Yang L, Hashmi M, Saleh M. Bicondylar Tibial plateau fractures managed with the Sheffield Hybrid fixator. Biomechanical study and operative technique. Injury.

Babis GC, Evangelopoulos DS, Kontovazenitis P, Nikolopoulos K, Soucacos PN. High energy tibial plateau fractures treated with hybrid external fixation. J Orthop Surg Res. 2011.

Watson JT, Ripple S, Hoshaw SJ, Fhyrie D. Hybrid external fixation for tibial plateau fractures: Clinical and biomechanical correlation. Orthop Clin North Am.

Metcalfe D, Hickson CJ, McKee L, Griffin XL. External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis. J Orthopaed Traumatol. 2015.

Buckley RE, Moran CGAT. AO Principles of Fracture Management. 3rd edition. 2017. Available at: https://www2.aofoundation.org/wps/portal/ surgerymobile?bone=Tibia&segment=Proximal&showPage=preparation. Accessed on 20 May 2020.