| Background: Pilon fractures caused by high-energy, because of its complex fracture type, severe injury of soft tissue and the high incidence of complications, for orthopedic surgeon, it is still a difficult problem and also a challenge. As the protection of soft tissue become a consensus,there are two main treatment in clinical currently:Open reduction and internal fixation(ORIF), external fixation combined with limited internal fixation(EFLIF). There are many reports about the two methods, but which is the best way are still inconclusive.Objective: Trough the Pubmed database,retrieval all of the relevant literature.Included the literature which conform to the standard in this study. Extract the data and get the result through statistical analysis. In order to understand the difference between ORIF and EFLIF for high-energy pilon fracture further. Finally can provide the reference value to the treatment of such pilon fracture in clinical.Methods: Based on comprehensive searches of the Pub Med(Subject heading: tibia fractures, subheadings:therapy, combined with free word “pilon”, from 1977 to 2014),Screening of the literature and extract the data. Use Cochrane Revman5.2 to get the result through statistical analysis. The results show in the form of forest figure.Results:1.Superficial soft tissue infection: In theory, the incidence of superficial soft tissue infection in ORIF group should be lower than the EFLIF group, and through the statistical analysis,we can find the incidence of superficial soft tissue infection in ORIF group was lower than that in EFLIF group,with significant difference. Consistent with the theory, so we can think in terms of incidence of soft tissue infection,ORIF group is better than EFLIF group.2.Nonunion: Because of the lower tibial blood supply is not very good, so it is increased the incidence of nonunion. Two-staged ORIF can protect the soft tissue around the fracture, little influence to the blood supply around the fracture and strictly follow the principle of treatment, this all have positive effect on the healing of fracture. The treatment of EFLIF also protect the soft tissue around the fracture,but its internal fixation isn’t stable. In statistical analysis,there is no significant difference between the two groups.3.Malunion: EFLIF group had higher rates of malunion, with no significant difference.But the statistical result is Z=1.86(P=0.06),OR:0.41(0.16-1.05). In theory, twe-staged ORIF can reduction and fixation the fracture by look straightly in second stage surgery,make the fracture get or near anatomical reduction, and have a stable internal fixation.But for EFLIF, it’s unable to get fully reduction and stable internal fixation. So we can think EFLIF group have higher rates of malunion, but there is no sufficient statistical evidence to our deduction.4. Osteomyelitis: In theory, because of the needle way of external fixation, formed a potential way into tissue around the fracture for pathogen, should have a higher incidence of osteomyelitis. but there is also no sufficient statistical evidence to our deduction.5. Arthrodesis: The main reason of the forward line joints arthrodesis:1. Intra-articular infection; 2. Post-traumatic arthrits. Severe pollution of open fracture and intraoperative probe,etc,can lead to intra-articular infection. The inadequate reduction of articular surface is the main reason for arthrodesis,a long-term complications. For what wementioned above, two-staged ORIF can reduction the articular surface by erthyphoria,the strategy of two stage also helps reduce the risk of intra-articular infection. Thereby,in theory two-staged ORIF should have lower incidence rate of arthrodesis, but there is no sufficient statistical evidence to our deduction.Conclusions: Incidence of superficial soft tissue infection in ORIF group was lower than that in EFLIF group,with significant difference. ORIF group had higher rates of nonunion, with no significant difference. EFLIF group had higher rates of malunion,with no significant difference. The rates of osteomyelitis and arthrodesis had no significant difference between the two groups. There are many limitations in the process of statistical analysis. But in clinical work, Surgeons need to consider many factors in the treatment of high-energy pilon fracture, And setting individualized treatment according to the characteristics of patients:choice of operation time, Suitable fixed way for different fracture type, precisely operation, well postoperative nursing,setting Suitable Functional exercise plan, In order to reduce the incidence of postoperative complications to a great extent, and Promote the recovery of joint function... |
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