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DOS Kongressen 2016 ·
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External Fixation versus two-stage Open
Reduction Internal Fixation of distal intra-articular
Tibia Fractures: a systematic review
Julie Ladeby Erichsen, Peter Andersen, Carsten Jensen, Frank Damborg, Bjarke
Viberg, Lonnie Froberg
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital;
Department of Orthopaedic Surgery and Traumatology, Odense University
Hospital
Background:
Distal Intra-Articular Tibia Fractures (DIATF) is challenging to
treat and severe loss of physical function affecting working abilities has been
reported.
Purpose / Aim of Study:
To investigate differences in physical function and
complications following DIATF surgery with two-stage Open Reduction Internal
Fixation (ORIF) or External Fixation (EF).
Materials and Methods:
A search was conducted using PUBMED, Embase,
Cochrane Central, Open Grey, Orthopaedic Proceedings and WHO International
Clinical Trials Registry Platform. Studies with level of evidence I-IV comparing
EF with two-stage ORIF of DIATF in patients (>18 years) were included for
review. 3071 studies were identified and screened by two independent authors
according to the PRISMA guidelines. Cochrane Risk of bias Tool for RCT and non-
randomised studies (ROBIN-1) were used to assess risk of bias.
Findings / Results:
One RCT study and four cohort studies with 254 patients,
150 two-stage ORIF and 104 EF, was included. The median follow-up ranged
from 12-38 months. The RCT had low risk of bias while the cohort studies had
moderate risk. All studies reported decreased physical function. A comparison
of results was difficult because a variety of function scores were used. EF had
a higher superficial infection frequency due to pinn infection (28% EF vs 9%
two-stage ORIF) and a tendency towards higher mal- and non-union frequency
(14% EF vs 7% two- stage ORIF; 6% EF vs 3% two-stage ORIF).
Conclusions:
Current evidence for physical function and complications follow-
ing DIATF surgery with either two-stage ORIF or EF is of low quality. However,
all present studies report decreased physical function following DIATF operated
on with either two-stage ORIF or EF. Number of complications was generally
low. A well-designed study with a large sample size is needed.
No conflicts of interest reported
112.