External fixator supplemented with screw fixation versus staged open reduction and internal fixation tibial pilon fracture

Objectives Two-stage open reduction and internal fixation (ORIF) and limited internal fixation combined with external fixation (LIFEF) are two widely used methods to treat Pilon injury. However, which method is superior to the other remains controversial. This meta-analysis was performed to quantitatively compare two-stage ORIF and LIFEF and clarify which method is better with respect to postoperative complications in the treatment of tibial Pilon fractures. Methods We conducted a meta-analysis to quantitatively compare the postoperative complications between two-stage ORIF and LIFEF. Eight studies involving 360 fractures in 359 patients were included in the meta-analysis. Results The two-stage ORIF group had a significantly lower risk of superficial infection, nonunion, and bone healing problems than the LIFEF group. However, no significant differences in deep infection, delayed union, malunion, arthritis symptoms, or chronic osteomyelitis were found between the two groups. Conclusion Two-stage ORIF was associated with a lower risk of postoperative complications with respect to superficial infection, nonunion, and bone healing problems than LIFEF for tibial Pilon fractures. Level of evidence 2.

Download Full-text

Can a linear external fixator stand as a surgical alternative to open reduction in treating a high-grade supracondylar humerus fracture?

Journal of International Medical Research ◽

10.1177/0300060518797022 ◽

2018 ◽

Vol 47 (1) ◽

pp. 133-141

Author(s):

Barak Rinat ◽

Eytan Dujovny ◽

Noam Bor ◽

Nimrod Rozen ◽

Guy Rubin

Keyword(s):

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Closed Reduction ◽

Open Reduction ◽

High Grade ◽

Supracondylar Humerus Fractures ◽

Long Term Follow Up ◽

Humerus Fractures ◽

Carrying Angle

Objective High-grade pediatric supracondylar humerus fractures are commonly treated with closed reduction and internal fixation with percutaneous pinning. When this fails, open reduction followed by internal fixation is the widely accepted procedure of choice. Use of a lateral external fixator was recently described as an optional procedure, but evidence is scarce. Methods We investigated the outcomes of upper limbs treated by either open reduction with internal fixation or closed reduction and external fixation. Results Twenty-one patients completed the long-term follow-up; 11 underwent open reduction, and 10 underwent external fixation. Most patients in both groups reported excellent satisfaction. In both groups, the modified Disabilities of the Arm, Shoulder, and Hand score was extremely low and the average elbow range of motion was almost identical. Radiographic analysis consisting of Baumann’s angle and the carrying angle revealed no statistical difference between the two groups. Discussion Optional treatment using a linear external fixator for complex nonreducible supracondylar humerus fractures yielded acceptable clinical and radiographic results, as with open reduction. Our sample size was small, but the promising results may assist in the implementation of an alternative surgical procedure, especially in more complicated cases involving flexion-type fractures or severe soft tissue damage and swelling.

Download Full-text