title: External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis.
abstract: BACKGROUND
  It is uncertain whether external fixation or open reduction internal fixation (ORIF) is optimal for patients with bicondylar tibial plateau fractures.
  
  
  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.
  
  
  CONCLUSIONS
  Although external fixation and ORIF are associated with different complication profiles, both are acceptable strategies for managing bicondylar tibial plateau fractures.
authors: Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. d.metcalfe@doctors.org.uk.|Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL, UK. d.metcalfe@doctors.org.uk.|Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. d.metcalfe@doctors.org.uk.
authors: David
authors: D
authors: Metcalfe
authors: Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.
authors: Craig J
authors: CJ
authors: Hickson
authors: Forth Valley Hospital, Stirling Road, Larbert, Scotland, UK.
authors: Lesley
authors: L
authors: McKee
authors: Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL, UK.
authors: Xavier L
authors: XL
authors: Griffin
mesh_terms: D016267:External Fixators; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal; D006801:Humans; D013978:Tibial Fractures / Q000601:surgery*
keywords: Bicondylar tibial plateau; External fixation; Internal fixation; Proximal tibial fracture