Purpose： Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation （ExFix） and open reduction and internal fixation （ORIF） are two widely used methods for repairing tibial ...Purpose： Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation （ExFix） and open reduction and internal fixation （ORIF） are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications. Methods： A computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library （before December 2014） for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference （WMD）, risk ratio （RR） and corresponding 95% confidence intervals （Cl） were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2. Results： Ten cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection （p = 0.13）, reduction （p = 0.11）, clinical evaluation （p = 0.82）, post-traumatic arthrosis Cp = 0.87）, and union time （p = 0.35）. Besides, ExFix group was found to have a higher rate of superficial infection （p = 0.001）, malunion （p = 0.01） and nonunion （p= 0.02）, but have a lower risk of unplanned hardware removal （p = 0.0002）. Conclusions： We suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, hut a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation. ~ost-traumatic arthrosis and union time.展开更多
Purpose： To compare the clinical efficacy and complications of limited internal fixation combined with external fixation （LIFEF） and open reduction and internal fixation （ORIF） in the treatment of Pilon fracture....Purpose： To compare the clinical efficacy and complications of limited internal fixation combined with external fixation （LIFEF） and open reduction and internal fixation （ORIF） in the treatment of Pilon fracture. Methods： We searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated. Results： Nine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate （RR 1.60, 95% CI： 0.66 to 3.86, p =0.30）, and the excellent/good rate （RR 0.95, 95% CI： 0.86 to 1.04, p= 0.28） between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection （RR 2.18, 95% CI： 1.34 to 3.55, p =0.002）, and the rate of arthritis （RR 1.26, 95% CI： 1.03 to 1.53, p =0.02） between LIFEF group and ORIF group. Conclusion： LIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture.展开更多
文摘Purpose： Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation （ExFix） and open reduction and internal fixation （ORIF） are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications. Methods： A computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library （before December 2014） for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference （WMD）, risk ratio （RR） and corresponding 95% confidence intervals （Cl） were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2. Results： Ten cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection （p = 0.13）, reduction （p = 0.11）, clinical evaluation （p = 0.82）, post-traumatic arthrosis Cp = 0.87）, and union time （p = 0.35）. Besides, ExFix group was found to have a higher rate of superficial infection （p = 0.001）, malunion （p = 0.01） and nonunion （p= 0.02）, but have a lower risk of unplanned hardware removal （p = 0.0002）. Conclusions： We suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, hut a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation. ~ost-traumatic arthrosis and union time.
基金This work was supported by the Fundamental Research Funds for the Central Universities, China （lzujbky-2014-k16） and the Na- tional Science Foundation for Distinguished Young Scholars of Gansu Province, China （No. 1210RJDA010）.
文摘Purpose： To compare the clinical efficacy and complications of limited internal fixation combined with external fixation （LIFEF） and open reduction and internal fixation （ORIF） in the treatment of Pilon fracture. Methods： We searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated. Results： Nine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate （RR 1.60, 95% CI： 0.66 to 3.86, p =0.30）, and the excellent/good rate （RR 0.95, 95% CI： 0.86 to 1.04, p= 0.28） between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection （RR 2.18, 95% CI： 1.34 to 3.55, p =0.002）, and the rate of arthritis （RR 1.26, 95% CI： 1.03 to 1.53, p =0.02） between LIFEF group and ORIF group. Conclusion： LIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture.
