Introduction
Materials and methods
Search strategy
Inclusion and exclusion criteria
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Reporting on human patients with bicondylar (OTA C1, C2, and C3) tibial plateau fractures.
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Direct comparison between any form of external fixation (including hybrid techniques utilizing percutaneous screw fixation) and ORIF.
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Reporting outcomes that were radiological (fracture reduction, union, subsequent OA) or clinical (functional scores, patient-reported outcomes, need for subsequent operation including arthroplasty), and/or post-operative complications (defined as any deleterious event described by study authors as post-operative complications).
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Reporting data from patients with peri-prosthetic and/or pathological fractures.
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Failure to analyze data on bicondylar fractures separately, e.g., populations including patients with unicondylar fractures. Authors were contacted for unpublished data in all such cases.
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Isolated case series of patients undergoing either ORIF or external fixation without distinction between treatment modalities.
Selection of studies
Quality assessment
Extraction of data
Statistical analysis
Results
Name | Design | Patients (knees) | Interventions | Follow-up | |
---|---|---|---|---|---|
External fixation | ORIF | ||||
Ahearn [14] | Retrospective | 21 | 34 | External fixation: Taylor Spatial Frame (TSF)a
ORIF: Incision: Unknown. Fixation: Lateral locking plate ± medial plate fixation | External fixation: mean 31 months (range 12–58 months) ORIF: mean 41 months (range 12–64 months) |
Boston Mallik [29] Covall [26] | Retrospective | 10 (10) | 7 (7) | External fixation: Monticelli-Spinellib circular fixator ORIF: Incision: Unknown. Fixation: Bilateral buttress, semi-tubular plates, or cannulated screws | External fixation: mean 10 months (range 5–28 months) ORIF: mean 33 months (range 6–60 months) |
Chertsey Guryel [34] Nawaz [33] | Retrospective | (79) | (45) | External fixation: Ilizarov circular frame ORIF: Incision: Unknown. Fixation: Unknown | Unknown |
COTS McKee [30] Pirani [32] | Randomized controlled trial | 42 (43) | 40 (40) | External fixation: Closed/percutaneous/limited reduction, percutaneous lag screw, and Ilizarov circular frame ORIF: Incision: Single anterior or combined medial/lateral. Fixation: medial and lateral non-locking buttress plates ± iliac crest bone grafting | 6, 12, and 24 months post-injury |
Chan [25] | Retrospective | 34 (35) | 24 (24) | External fixation: Ilizarov circular frame (23/35, 65.7 %), Hoffman IIb with limited internal fixation (13/35, 37.1 %) ORIF: Incision: Unknown. Fixation: Buttress plate (21/24, 84 %), Less Invasive Stabilization Systemc (4/24, 16 %) | 3, 6, 12, and 24 months post-injury |
Jansen [5] | Retrospective | 2 (2) | 20 (21) | External fixation: Synthes AOc fixator or Ilizarov circular frame ORIF: Incision: Unknown. Fixation: LISSc (19/20, 95.0 %) ± additional plates (7/20, 30.4 %) ± artificial bone substitute (7/20, 30.4 %) | Mean 67 months (range 36–109 months) |
Krupp [28] | Retrospective | 30 (30) | 28 (28) | External fixation: Hoffman II Hybridb (16/28, 57.1 %) or circular (14/28, 50.0 %) frames and interval ORIF (locking plate or LISSc) ORIF: Incision: Unknown. Fixation: locking plate (8/28, 28.6 %), LISSc (20/28, 71.4 %) | Mean unknown (range 6–53 months) |
Study characteristics
Study quality
Sequence generation | Allocation concealment | Blinding of participants, personnel and outcome assessors | Incomplete outcome data | Selective outcome reporting | Other sources of bias | |
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COTS McKee [30] Pirani [32] | Low risk | Low risk | High risk | Low risk | Unclear risk | Low risk |
Selection of participants | Confounding variables | Intervention measurement | Blinding of outcome assessment | Incomplete outcome data | Selective outcome reporting | |
---|---|---|---|---|---|---|
Ahearn [31] | Low risk | High risk | Low risk | Unclear risk | High risk | Unclear risk |
Boston Mallik [29] Covall [26] | Low risk | High risk | Low risk | Unclear risk | High risk | Unclear risk |
Chertsey Guryel [34] Nawaz [33] | Low risk | High risk | Low risk | Unclear risk | Low risk | Unclear risk |
Chan [25] | Low risk | High risk | Low risk | Unclear risk | High risk | Unclear risk |
Jansen [5] | Unclear risk | High risk | Low risk | Unclear risk | Low risk | Unclear risk |
Krupp [28] | Low risk | High risk | Low risk | Unclear risk | High risk | Unclear risk |