title: Clinical efficacy and safety of limited internal fixation combined with external fixation for Pilon fracture: A systematic review and meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedics, Key Laboratory of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730030, China.
authors.forename: Shao-Bo
authors.initials: SB
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Key Laboratory of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730030, China.
authors.forename: Yi-Bao
authors.initials: YB
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Key Laboratory of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730030, China.
authors.forename: Sheng-Hong
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Key Laboratory of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730030, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Key Laboratory of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730030, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Key Laboratory of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730030, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Key Laboratory of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730030, China.
authors.forename: Jing-Lin
authors.initials: JL
authors.lastname: Ma
authors.affiliation: Department of Orthopedics, Key Laboratory of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730030, China. Electronic address: wang_jing@lzu.edu.cn.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
mesh_terms: D003131:Combined Modality Therapy; D016267:External Fixators; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D013978:Tibial Fractures / Q000601:surgery*
keywords: External fixators; Fracture fixation, internal; Meta-analysis; Pilon fractures