Posterior-Based Approaches to Open Reduction Internal Fixation of Bimalleolar and Trimalleolar Fractures: A Systematic Review and Meta-analysis |
| |
| Affiliation: | 1. Epidemiologist, Global Research Solutions, Burlington, ON, Canada;2. Research Scientist, OrthoEvidence Inc., Burlington, ON, Canada;3. Professor & Orthopaedic Surgeon, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada;4. Professor & Orthopaedic Surgeon, Department of Surgery, McMaster University, Hamilton, ON, Canada;5. Orthopaedic Surgeon, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC;1. Orthopaedic Resident, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece;2. Orthopaedic Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece;3. Anesthesiologist Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece;4. Orthopaedic Professor, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece;1. Radiologist, Victoria House Medical Imaging, South Yarra, Victoria, Australia;2. Surgeon, Northern Health, Epping, Victoria, Australia;3. Surgeon, St Vincent''s Private Hospital East Melbourne, East Melbourne, Victoria, Australia;4. Radiographer, Victoria House Medical Imaging, South Yarra, Victoria, Australia;5. Anaesthetist, St Vincent''s Hospital Melbourne, Fitzroy, Victoria, Australia;6. Surgeon, Epworth Richmond Hospital, Richmond, Victoria, Australia;1. Program Director, Cleveland VA Podiatric Medicine and Surgery Residency, Reconstructive Rearfoot/Ankle Surgery, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH;2. Chief of Surgery, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio;3. Postgraduate Year 3, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH;1. Department of Surgery of 1st Faculty of Medicine, Charles University and Thomayer Hospital, Videnska 800, Prague 4, 140 00, Czech Republic;2. Department of Orthopaedics, First Faculty of Medicine, Charles University and Central Military Hospital, U Vojenské nemocnice 1200, Prague 6, 169 02, Czech Republic;3. University Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Germany |
| |
| Abstract: | Although there is growing evidence supporting posterior-based surgical approaches to open reduction internal fixation (ORIF) of malleolar fractures, the lateral approach still remains the standard of care for this injury. The purpose of this review was to integrate the results of several studies investigating outcomes following posterior-based approaches to the ORIF of malleolar fractures. The literature search was undertaken using PubMed, the Cochrane Library, and Embase. Crude event rates for fracture healing and postoperative complications were calculated. When possible, meta-analyses were conducted to estimate the relative risk of these outcomes between patients treated by posterior-based approaches versus other approaches to ORIF of malleolar fractures. Twenty-two studies were eligible, and 4 studies were included in the meta-analyses. The healing rate was 100% in all patients, regardless of the surgical approach. Overall, 1.26% of patients developed an infection, 0.63% required reoperation, 1.13% experienced aseptic loosening, 5.53% experienced pain after treatment, and 2.52% experienced symptomatic hardware. No malunion or heterotopic ossification was reported in any study. Among patients treated with a posterior-based approach, the most frequently reported complication was infection (2.50%), with lower rates of reoperation and postoperative pain. Patients with trimalleolar fractures experienced slightly poorer outcomes. Patients treated by posterior-based approaches had a significantly increased risk of infection (p = .010) relative to those treated by the lateral approach; patients treated by the lateral approach had a significantly increased risk of pain after surgery (p = .004) and symptomatic hardware (p = .007). This study brought together evidence that posterior-based surgical approaches and non–posterior-based approaches to ORIF are effective in healing malleolar fractures, with significant differences in specific postoperative complications that need to be further explored. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
