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Journal of Orthopaedics and Traumatology

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Open Access 01-12-2015 | Review Article

External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis

Authors: David Metcalfe, Craig J. Hickson, Lesley McKee, Xavier L. Griffin

Published in: Journal of Orthopaedics and Traumatology | Issue 4/2015

Abstract

Background

It is uncertain whether external fixation or open reduction internal fixation (ORIF) is optimal for patients with bicondylar tibial plateau fractures.

Materials and methods

A systematic review using Ovid MEDLINE, Embase Classic, Embase, AMED, the Cochrane Library, Open Grey, Orthopaedic Proceedings, WHO International Clinical Trials Registry Platform, Current Controlled Trials, US National Institute for Health Trials Registry, and the Cochrane Central Register of Controlled Trials. The search was conducted on 3rd October 2014 and no language limits were applied. Inclusion criteria were all clinical study designs comparing external fixation with open reduction internal fixation of bicondylar tibial plateau fractures. Studies of only one treatment modality were excluded, as were those that included unicondylar tibial plateau fractures. Treatment effects from studies reporting dichotomous outcomes were summarised using odds ratios. Continuous outcomes were converted to standardized mean differences to assess the treatment effect, and inverse variance methods used to combine data. A fixed effect model was used for meta-analyses.

Results

Patients undergoing external fixation were more likely to have returned to preinjury activities by six and twelve months (P = 0.030) but not at 24 months follow-up. However, external fixation was complicated by a greater number of infections (OR 2.59, 95 % CI 1.25–5.36, P = 0.01). There were no statistically significant differences in the rates of deep infection, venous thromboembolism, compartment syndrome, or need for re-operation between the two groups.

Conclusion

Although external fixation and ORIF are associated with different complication profiles, both are acceptable strategies for managing bicondylar tibial plateau fractures.

Level of evidence

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Title: External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis
Authors: David Metcalfe
Craig J. Hickson
Lesley McKee
Xavier L. Griffin
Publication date: 01-12-2015
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 4/2015
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-015-0372-9

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External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis

Abstract

Background

Materials and methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

Level of evidence

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