title: A meta-analysis of external fixation versus open reduction and internal fixation for complex tibial plateau fractures.
abstract: OBJECTIVE
  Both external fixation (ExFx) and open reduction and internal fixation(ORIF) were used to treat complex tibial plateau fractures, but it was not sure which one was better. So we did this meta-analysis to evaluate the outcomes of ExFx and ORIF in managing complex tibial plateau fractures.
  
  
  METHODS
  Articles published before August 5, 2016 were selected from PubMed, Cochrane library, and some other electronic database. Relevant journals were also searched manually with no language limited. Two independent reviewers searched and assessed the literature. A fixed effect model was initially used for meta-analyses with RevMan 5.3.
  
  
  RESULTS
  When compared with ORIF, cases undergoing ExFx were more likely to return to the preinjury state at the early stage, but no difference in the later period of follow-up. However, ExFx group had higher infection rate (OR 1.98, 95% CI 1.08-3.63, P = 0.03), higher venous thromboembolism rate (OR 1.56, 95% CI 0.49-4.96, P = 0.45), higher re-operation rate (OR 0.87, 95% CI 0.47-1.62, P = 0.66) and lower compartment syndrome rate (OR 0.61, 95% CI 0.12-3.22, P = 0.56), lower TKA rate (OR 0.51, 95% CI 0.20-1.34, P = 0.17). There were no statistically significant differences in the rate of deep infection, venous thromboembolism, compartment syndrome and VTE between the two groups.
  
  
  CONCLUSIONS
  Although external fixation may offer some advantages, both were acceptable strategies in managing complex tibial plateau fractures. According to our analysis results, we strongly recommend that selection of definitive fixators should base on the fracture patterns, soft-tissue condition as well as the injury stages in clinical practice. More important, further multicentered, randomized controlled studies should be implemented to get a more reliable and clear result.
authors.affiliation: The Orthopaedic Institute, Tianjin Hospital, Tianjin 300050, People's Republic of China; Tianjin Medical University, Tianjin 30070, People's Republic of China. Electronic address: longlongwin@sina.cn.
authors.forename: Xing-Wen
authors.initials: XW
authors.lastname: Zhao
authors.affiliation: The Orthopaedic Institute, Tianjin Hospital, Tianjin 300050, People's Republic of China. Electronic address: 1638977822@qq.com.
authors.forename: Jian-Xiong
authors.initials: JX
authors.lastname: Ma
authors.affiliation: The Orthopaedic Institute, Tianjin Hospital, Tianjin 300050, People's Republic of China; Tianjin Medical University, Tianjin 30070, People's Republic of China; Department of Orthopaedics, Tianjin Hospital, Tianjin 300211, People's Republic of China. Electronic address: 446483619@qq.com.
authors.forename: Xin-Long
authors.initials: XL
authors.lastname: Ma
authors.affiliation: The Orthopaedic Institute, Tianjin Hospital, Tianjin 300050, People's Republic of China; Department of Orthopaedics, Tianjin Hospital, Tianjin 300211, People's Republic of China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Jiang
authors.affiliation: The Orthopaedic Institute, Tianjin Hospital, Tianjin 300050, People's Republic of China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: The Orthopaedic Institute, Tianjin Hospital, Tianjin 300050, People's Republic of China; Tianjin Medical University, Tianjin 30070, People's Republic of China.
authors.forename: Fei
authors.initials: F
authors.lastname: Li
authors.affiliation: The Orthopaedic Institute, Tianjin Hospital, Tianjin 300050, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Lu
mesh_terms: D000328:Adult; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology
keywords: Complex tibial plateau fractures; External fixation (ExFx); Open reduction and internal fixation (ORIF)