A meta-analysis of postoperative complications in tibial Pilon fracture: open reduction and internal fixation versus limited internal fixation combined with external fixator

doi:10.3877/cma.j.issn.1674-0785.2017.17.003

Abstract

Abstract:

Objective

To perform a meta-analysis to analyze the advantages and disadvantages of open reduction and internal fixation (ORIF) versus limited internal fixation combined with external fixator (LIFEF), to provide rational clinical diagnosis and treatment methods for orthopedic surgeons and provide a theoretical basis for the development of guidelines.

Methods

Controlled clinical trials on ORIF and LIFEF for the treatment of tibial Pilon fracture were searched in PubMed, Science Direct, Wiley Online Library, Cochrane Library, CNKI, VIP, and Wanfang databases. Data were screened, extracted, and evaluated by two independent researchers. A meta-analysis was performed using STATA12.0.

Results

Thirty-six studies with 2054 fractures in 2054 patients were included in the present study. We found that there were significant differences in Ankle score of Mazuretal (RR=1.10, 95% CI: 1.02-1.19, P=0.021), osteomyelitis (RR=0.47, 95% CI: 0.23-0.96, P=0.015), and traumatic arthritis (RR=1.55, 95% CI: 1.22-1.96, P=0.00), but no significant difference in soft tissue infection (RR=1.13, 95% CI: 0.78-1.64, P=0.511).

Conclusion

LIFEF is associated with a lower rate of overall incidence complications than ORIF and may have better effect.

Key words: Open reduction and internal fixation, External fixation, Limited internal fixation, Tibial Pilon fracture, Meta-analysis

Zinan Zhang, Haibiao Sun, Jian Chen, Xiaoqiang Han, Junchao Fang. A meta-analysis of postoperative complications in tibial Pilon fracture: open reduction and internal fixation versus limited internal fixation combined with external fixator[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(17): 2173-2183.

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Figures/Tables 12

References 45

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文献作者/年份	国家	设计方案	年龄	女/男	骨折分型及例数	闭合/开放	分组	随访时间（月）	结果	NOS评分
Zhang 2012^[7]	China	RCT	31.9	14/24	Ⅰ: 21 Ⅱ: 26 Ⅲ: 29	-	ORIF=38 LIFEF=38	12.3±0.5	LIFEF	-
Tu 2015^[8]	China	RCT	-	-	-	-	ORIF=40 LIFEF=30	11.5±0.5	LIFEF	-
Mo 2011^[9]	China	Retrospective	27.4	11/23	Ⅱ: 25	-	ORIF=16 LIFEF=18	26.4±3.0	ORIF	6
Wang 2013^[10]	China	Retrospective	46.8	57/63	Ⅱ: 74	53/67	ORIF=60 LIFEF=60	6	LIFEF	7
Jiu 2013^[11]	China	Retrospective	-	23/37	Ⅱ: 35 Ⅲ: 25	21/39	ORIF=30 LIFEF=30	-	LIFEF	6
Jiang 2016^[12]	China	RCT	-	36/39	-	-	ORIF=37 LIFEF=38	-	LIFEF	-
Su 2014^[13]	China	Retrospective	38	-	Ⅰ: 15 Ⅱ: 32 Ⅲ: 23	-	ORIF=33 LIFEF=37	-	LIFEF	7
Lu 2012^[14]	China	Retrospective	42.2	8/53	Ⅱ: 51 Ⅲ: 10	46/15	ORIF=39 LIFEF=22	12.3±3.0	LIFEF	7
Liu 2014^[15]	China	Retrospective	35.2	14/48	A: 17 B: 19 C: 26	51/11	ORIF=31 LIFEF=31	-	ORIF	6
Liu 2013^[16]	China	RCT	-	19/47	A: 18 B: 35 C: 13	-	ORIF=33 LIFEF=33	-	LIFEF	-
Sun 2014^[17]	China	Retrospective	36.3	12/30	Ⅱ: 26 Ⅲ: 16	14/28	ORIF=22 LIFEF=10	18.21±2.3	ORIF	6
Liu 2014^[18]	China	Retrospective	-	13/29	C3: 13	27/15	ORIF=24 LIFEF=18	24	NR	6
Yang 2014^[19]	China	Retrospective	32.5	17/39	C2: 34 C3: 22	32/24	ORIF=22 LIFEF=24	17.3	LIFEF	6
Xu 2016^[20]	China	Retrospective	33	18/40	C2: 35 C3: 23	33/25	ORIF=30 LIFEF=28	-	ORIF	6
Yu 2015^[21]	China	Retrospective	-	-	Ⅰ: 25 Ⅱ: 27 Ⅲ: 16	-	ORIF=34 LIFEF=34	24	LIFEF	6
Zheng 2013^[22]	China	RCT	-	19/61	-	31/49	ORIF=40 LIFEF=40	-	LIFEF	-
Yang 2012^[23]	China	RCT	42.5	18/42	Ⅱ: 35 Ⅲ: 25	24/36	ORIF=30 LIFEF=30	-	LIFEF	-
Pang 2012^[24]	China	RCT	43.5	27/49	Ⅰ: 17 Ⅱ: 38 Ⅲ: 21	58/18	ORIF=38 LIFEF=38	-	LIFEF	-
Duan 2014^[25]	China	Retrospective	-	14/19	Ⅲ: 33	-	ORIF=11 LIFEF=12	-	LIFEF	7
Tai 2016^[26]	China	Retrospective	-	27/37	?	-	ORIF=32 LIFEF=32	-	-	6
Zhao 2015^[27]	China	RCT	-	34/46	B3: 7 C1: 38 C2: 26 C3: 9	-	ORIF=40 LIFEF=40	-	LIFEF	-
Guo 2015^[28]	China	Retrospective	-	22/56	Ⅲ: 78	-	ORIF=26 LIFEF=52	15.7	ORIF	8
Fan 2012^[29]	China	Retrospective	-	37/61	Ⅲ: 98	69/29	ORIF=56 LIFEF=42	14.5±2.5	LIFEF	6
Zheng 2014^[30]	China	Retrospective	41.2	48/72	Ⅱ: 62 Ⅲ: 58	60/60	ORIF=80 LIFEF=40	-	-	7
Bacon 2008^[31]	USA	Retrospective	37	7/31	C1: 4 C2: 10 C3:24	32/6	ORIF=25 LIFEF=13	-	-	5
Blauth 2001^[32]	USA	Retrospective	40	-	B2: 3 B3: 1 C1: 2 C2: 26 C3: 19	32/19	ORIF=8 LIFEF=28	-	-	-
Koulouvaris 2007^[33]	USA	Retrospective	45.4	-	B2: 11 B3: 1 C1: 13 C2: 6 C3: 4	20/15	ORIF=13 LIFEF=22	-	ORIF	5
Elkataran 2011^[34]	USA	Retrospective	41	16/31	C1: 5 C2: 10 C3: 32	38/9	ORIF=26 LIFEF=21	20	LIFEF	5
Wang 2010^[35]	China	Retrospective	39	5/51	B3: 5 C1: 16 C2: 23 C3: 12	56/0	ORIF=27 LIFEF=28	24	ORIF	6
Wyrsch 1996^[36]	USA	RCT	-	12/27	Ⅰ: 8 Ⅱ: 14 Ⅲ: 17	29/10	ORIF=19 LIFEF=20	24	LIFEF	-
文献作者/年份	国家	设计方案	年龄	女/男	骨折分型及例数	闭合/开放	分组	随访时间（周/月）	结果	NOS评分
Justin 2012^[37]	USA	Cohort	-	-	-	32/13	ORIF=27 LIFEF=18	12	-	5
Harris 2006^[38]	USA	Retrospective	45	31/45	B: 11 C1: 15 C2: 10 C3: 53	58/21	ORIF=63 LIFEF=16	26	-	5

文献作者/年份	国家	设计方案	年龄	女/男	骨折分型及例数	闭合/开放	分组	随访时间（月）	结果	NOS评分
Zhang 2012^[7]	China	RCT	31.9	14/24	Ⅰ: 21 Ⅱ: 26 Ⅲ: 29	-	ORIF=38 LIFEF=38	12.3±0.5	LIFEF	-
Tu 2015^[8]	China	RCT	-	-	-	-	ORIF=40 LIFEF=30	11.5±0.5	LIFEF	-
Mo 2011^[9]	China	Retrospective	27.4	11/23	Ⅱ: 25	-	ORIF=16 LIFEF=18	26.4±3.0	ORIF	6
Wang 2013^[10]	China	Retrospective	46.8	57/63	Ⅱ: 74	53/67	ORIF=60 LIFEF=60	6	LIFEF	7
Jiu 2013^[11]	China	Retrospective	-	23/37	Ⅱ: 35 Ⅲ: 25	21/39	ORIF=30 LIFEF=30	-	LIFEF	6
Jiang 2016^[12]	China	RCT	-	36/39	-	-	ORIF=37 LIFEF=38	-	LIFEF	-
Su 2014^[13]	China	Retrospective	38	-	Ⅰ: 15 Ⅱ: 32 Ⅲ: 23	-	ORIF=33 LIFEF=37	-	LIFEF	7
Lu 2012^[14]	China	Retrospective	42.2	8/53	Ⅱ: 51 Ⅲ: 10	46/15	ORIF=39 LIFEF=22	12.3±3.0	LIFEF	7
Liu 2014^[15]	China	Retrospective	35.2	14/48	A: 17 B: 19 C: 26	51/11	ORIF=31 LIFEF=31	-	ORIF	6
Liu 2013^[16]	China	RCT	-	19/47	A: 18 B: 35 C: 13	-	ORIF=33 LIFEF=33	-	LIFEF	-
Sun 2014^[17]	China	Retrospective	36.3	12/30	Ⅱ: 26 Ⅲ: 16	14/28	ORIF=22 LIFEF=10	18.21±2.3	ORIF	6
Liu 2014^[18]	China	Retrospective	-	13/29	C3: 13	27/15	ORIF=24 LIFEF=18	24	NR	6
Yang 2014^[19]	China	Retrospective	32.5	17/39	C2: 34 C3: 22	32/24	ORIF=22 LIFEF=24	17.3	LIFEF	6
Xu 2016^[20]	China	Retrospective	33	18/40	C2: 35 C3: 23	33/25	ORIF=30 LIFEF=28	-	ORIF	6
Yu 2015^[21]	China	Retrospective	-	-	Ⅰ: 25 Ⅱ: 27 Ⅲ: 16	-	ORIF=34 LIFEF=34	24	LIFEF	6
Zheng 2013^[22]	China	RCT	-	19/61	-	31/49	ORIF=40 LIFEF=40	-	LIFEF	-
Yang 2012^[23]	China	RCT	42.5	18/42	Ⅱ: 35 Ⅲ: 25	24/36	ORIF=30 LIFEF=30	-	LIFEF	-
Pang 2012^[24]	China	RCT	43.5	27/49	Ⅰ: 17 Ⅱ: 38 Ⅲ: 21	58/18	ORIF=38 LIFEF=38	-	LIFEF	-
Duan 2014^[25]	China	Retrospective	-	14/19	Ⅲ: 33	-	ORIF=11 LIFEF=12	-	LIFEF	7
Tai 2016^[26]	China	Retrospective	-	27/37	?	-	ORIF=32 LIFEF=32	-	-	6
Zhao 2015^[27]	China	RCT	-	34/46	B3: 7 C1: 38 C2: 26 C3: 9	-	ORIF=40 LIFEF=40	-	LIFEF	-
Guo 2015^[28]	China	Retrospective	-	22/56	Ⅲ: 78	-	ORIF=26 LIFEF=52	15.7	ORIF	8
Fan 2012^[29]	China	Retrospective	-	37/61	Ⅲ: 98	69/29	ORIF=56 LIFEF=42	14.5±2.5	LIFEF	6
Zheng 2014^[30]	China	Retrospective	41.2	48/72	Ⅱ: 62 Ⅲ: 58	60/60	ORIF=80 LIFEF=40	-	-	7
Bacon 2008^[31]	USA	Retrospective	37	7/31	C1: 4 C2: 10 C3:24	32/6	ORIF=25 LIFEF=13	-	-	5
Blauth 2001^[32]	USA	Retrospective	40	-	B2: 3 B3: 1 C1: 2 C2: 26 C3: 19	32/19	ORIF=8 LIFEF=28	-	-	-
Koulouvaris 2007^[33]	USA	Retrospective	45.4	-	B2: 11 B3: 1 C1: 13 C2: 6 C3: 4	20/15	ORIF=13 LIFEF=22	-	ORIF	5
Elkataran 2011^[34]	USA	Retrospective	41	16/31	C1: 5 C2: 10 C3: 32	38/9	ORIF=26 LIFEF=21	20	LIFEF	5
Wang 2010^[35]	China	Retrospective	39	5/51	B3: 5 C1: 16 C2: 23 C3: 12	56/0	ORIF=27 LIFEF=28	24	ORIF	6
Wyrsch 1996^[36]	USA	RCT	-	12/27	Ⅰ: 8 Ⅱ: 14 Ⅲ: 17	29/10	ORIF=19 LIFEF=20	24	LIFEF	-
文献作者/年份	国家	设计方案	年龄	女/男	骨折分型及例数	闭合/开放	分组	随访时间（周/月）	结果	NOS评分
Justin 2012^[37]	USA	Cohort	-	-	-	32/13	ORIF=27 LIFEF=18	12	-	5
Harris 2006^[38]	USA	Retrospective	45	31/45	B: 11 C1: 15 C2: 10 C3: 53	58/21	ORIF=63 LIFEF=16	26	-	5

因素	?	I-squared（%）	Heterogeneity	RR（95% CI）	P值
踝关节评分	#	53.70	P=0.001	1.10（1.02~1.19）	0.014
?	&	24.60	P=0.264	0.94（0.78~1.12）	0.013
总并发症	组织感染	36.00	P=0.121	1.13（0.78~1.64）	0.511
?	骨髓炎	26.00	P=0.231	0.47（0.23~0.96）	0.039
?	创伤性关节炎	27.20	P=0.138	1.55（1.22~1.96）	0.000
亚组分析	?	56.00	P=0.001	0.49（0.30~0.82）	0.008
?	ⅠⅡⅢ型	1.40	P=0.363	0.41（0.20~0.84）	0.015
	ⅡⅢ型	0.00	P=0.526	0.28（0.13~0.59）	0.001
	B&C型	9.10	P=0.294	2.98（1.23~7.22）	0.016
	C型	0.00	P=0.467	0.83（0.41~1.69）	0.603

因素	?	I-squared（%）	Heterogeneity	RR（95% CI）	P值
踝关节评分	#	53.70	P=0.001	1.10（1.02~1.19）	0.014
?	&	24.60	P=0.264	0.94（0.78~1.12）	0.013
总并发症	组织感染	36.00	P=0.121	1.13（0.78~1.64）	0.511
?	骨髓炎	26.00	P=0.231	0.47（0.23~0.96）	0.039
?	创伤性关节炎	27.20	P=0.138	1.55（1.22~1.96）	0.000
亚组分析	?	56.00	P=0.001	0.49（0.30~0.82）	0.008
?	ⅠⅡⅢ型	1.40	P=0.363	0.41（0.20~0.84）	0.015
	ⅡⅢ型	0.00	P=0.526	0.28（0.13~0.59）	0.001
	B&C型	9.10	P=0.294	2.98（1.23~7.22）	0.016
	C型	0.00	P=0.467	0.83（0.41~1.69）	0.603

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