Comparison between open reduction with internal fixation to circular external fixation for tibial plateau fractures: A systematic review and meta-analysis

Peer-reviewed published studies on tibial plateau fractures treated with either open reduction with internal fixation (ORIF) or circular external fixation were reviewed to compare functional, radiological outcomes, postoperative complications, and reoperation rates between the two methods. A systematic search of various databases including Medline, Cochrane Controlled Register of Trials (CENTRAL), ScienceDirect, and Google Scholar from inception until June 2019 was performed. 17 studies with 1168 participants were included in the review. Most of the studies (76%) were retrospective in nature and had low or unclear bias risks. Incidence of total infection (Odds ratio [OR], 2.58; 95% CI, 1.33–5.02) and malunions (OR, 2.56; 95% CI, 1.12–5.84) were higher and length of hospital stay was shorter in patients treated with circular external fixator (Mean difference [MD], -6.1; 95% CI, -11.1–-1.19). There were no differences in the incidence of secondary osteoarthritis (OR, 1.49; 95% CI, 0.92–2.42), range of motion (MD, 2.28; 95% CI, -11.27–15.82) non-union (OR, 1.44; 95% CI, 0.14–14.27) and reoperation rates (OR, 1.84; 95% CI, 0.90–3.78) between the two groups. Results from this investigation suggest that circular fixation may offer some advantages over ORIF such as a shortened length of hospital stay and early return to preinjury activities. Definitive clinical recommendations cannot be made as it also presents higher rates of postoperative complications than ORIF.