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

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.