![]() Often, complex fractures are set surgically through open reduction and internal fixation (ORIF), which entails exposing the fracture to direct view and then fastening the bone fragments into place with metal plates and screws. These fractures are often associated with a large amount of damage to the skin and muscle and may cause voids or defects in the bone. Surgical fixation methods for treating tibial plateau fractures (breaks in the top end of the shin bone) in adultsįractures of the tibial plateau are injuries affecting the top end of the tibia (shin bone), which forms the lower bone surface in the knee joint. Two trials reported similar range of motion results in the two groups, whereas the third trial favoured the bone substitute group. However, all 38 participants in the autologous iliac bone graft group of one trial reported prolonged pain from the harvest site. One trial found no cases of inflammatory response in the 20 participants receiving bone substitute, and two found no complications associated with the donor site in the autograft group (58 participants). The incidences of individual complications were similar between groups in all three trials. Only one trial (25 participants) reported on lower limb function, finding good or excellent results in both groups for walking, climbing stairs, squatting and jumping at 12 months. Quality of life, pain and return to pre‐injury activity were not reported. Three trials compared different types of bone substitute versus autologous bone graft (autograft) for managing bone defects. There was very low quality evidence of higher HSS knee scores and higher knee range of motion values in the arthroscopically assisted group. A quasi‐randomised trial comparing arthroscopically‐assisted percutaneous reduction and internal fixation versus standard ORIF reported results at 14 months in 58 people with closed Schatzker types II or III tibial plateau fracture. The trial provided no evidence of differences in HSS knee scores, complications or reoperation entailing implant removal or revision fixation. Quality of life, pain, knee range of motion and return to pre‐injury activity were not reported. Nearly twice as many participants (22 versus 12) in the ORIF group had a bone graft. Results of the two groups were comparable for the WOMAC pain subscale and stiffness scores, but mean knee range of motion values were higher in the hybrid group.Īnother trial compared the use of a minimally invasive plate (LISS system) versus double‐plating ORIF in 84 people who had open or closed bicondylar tibial plateau fractures. Participants in the hybrid fixation group had a lower risk for an unplanned reoperation (3 people compared with 450 in the ORIF group 95% CI 197 fewer to 144 more) and were more likely to have returned to their pre‐injury activity level (3 people, compared with 121 in the ORIF group 95% CI 15 fewer to 748 more). Results (66 participants) for quality of life scores using the 36‐item Short Form Health Survey (SF‐36)), Hospital for Special Surgery (HSS) scores and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scores tended to favour hybrid fixation, but a benefit of ORIF could not be ruled out. One trial compared the use of a circular fixator combined with insertion of percutaneous screws (hybrid fixation) versus standard open reduction and internal fixation (ORIF) in people with open or closed Schatzker types V or VI tibial plateau fractures. We judged the quality of most of the available evidence to be very low, meaning that we are very uncertain about these results. All six trials were small and at substantial risk of bias. Three trials evaluated different types of fixation and three analysed different types of bone graft substitutes. We included six trials in the review, with a total of 429 adult participants, the majority of whom were male (63%).
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