Circular fixator application for bicondylar tibial plateau fractures reduces hospital stay .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(3):41 J Bone Joint Surg Am. 2006 Dec;88(12):2613-23.82 patients with 83 displaced bicondylar tibial plateau fractures were randomized to receive standard open reduction and internal fixation with medial and lateral plates or percutaneous and/or limited open fixation and application of a circular fixator. At the 2 year follow-up there was no significant difference in clinical outcomes between the open reduction group and circular fixator group, however, a marginally faster return to function was observed at 6 months in the circular fixator group. Additionally, patients in the circular fixator group required a significantly shorter hospital stay than the patients in the internal fixation group, and the open reduction and internal fixation group exhibited significantly more complications.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
2/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Open reduction and internal fixation (ORIF) of bicondylar fractures of the tibial plateau is the current gold standard for treatment. However, damage caused by the original injury and the surgical procedure can lead to a high rate of complication. Alternative methods of treating bicondylar fractures of the tibial plateau have become increasingly common due to negative effects of complications associated with ORIF. One of these alternative treatments is circular frame fixation with or without percutaneous lag-screw fixation. This study aimed to determine whether percutaneous and/or limited open fixation and application of a circular fixator provides better fracture reduction quality than standard open reduction and internal fixation with medial and lateral plates.
Qual era a principal questão de investigação?
Does percutaneous and/or limited open fixation and application of a circular fixator improve clinical outcomes of patients with displaced bicondylar tibial plateau fractures when compared to open reduction and internal fixation with medial and lateral plates 2 years after surgery?
- At 6 months, the HSS knee score was 72 for the circular fixator group and 61 for the open reduction group (p=0.064). At 1 year the HSS knee score was 72 for the circular fixator group and 67 for the open reduction group (p=0.406). At 2 years, the HSS knee score was 75 for the circular fixator group and 68 for the open reduction group, which was found to be not statistically significant (p=0.307).
- The difference in mean pain, stiffness, or function on the WOMAC score between the circular fixator group and open reduction group at 6 months, 1 year, and 2 years was found to be not clinically significant (p>0.05), and no difference in total arc of knee motion was apparent (p>0.05).
- Both the circular fixator group and open reduction group achieved significantly lower mean WOMAC scores at the 2 year follow-up relative to preoperative scores (p<0.05).
- The difference between preoperative and 2 year follow-up SF-36 scores were found to be clinically significant for both the circular fixator group (p=0.001) and the open reduction group (p=0.014). At the 2 year follow-up, the difference between the circular fixator group and open reduction group was not significant for all SF-36 domains except for the bodily pain domain, which was significantly better for the circular fixator group (p=0.041).
- The circular fixation group required a significantly shorter hospital stay (9.9 days) than the open fixation group (23.4 days) (p=0.024) along with significantly less Intraoperative blood loss (213 mL vs. 544 mL respectively; p= 0.006).
- The quality of osseous reduction was similar between groups. Patient ability to return to preinjury activities at 6 months and 12 months was superior in the circular fixation group compared to the ORIF groups (p=0.031 and p=0.024 respectively) but not at 2 years.
- 7 (18%) ORIF patients reported a deep infection. The number of unplanned repeat surgical interventions, along with their severity, was greater in the ORIF group (37 procedures) compared with the circular fixator group (16 procedures) (p= 0.001).
De que é que me devo lembrar mais?
The data suggested that percutaneous and/or limited open fixation and application of a circular fixator did not significantly improve clinical outcomes of the knee but significantly reduced the required hospital stay when compared to standard open reduction and internal fixation with medial and lateral plates. Complications were also significantly more incident in the open reduction and internal fixation group.
Como é que isto afectará o tratamento dos meus doentes?
The study suggests that percutaneous and/or limited open fixation and application of a circular fixator may not significantly improve clinical outcomes when compared to standard open reduction and internal fixation with medial and lateral plates over a 2 year follow-up period. Further research using larger sample sizes are required to confirm the findings of this study.
AVISO LEGAL
O conteúdo desta página destina-se apenas a fins informativos e não pretende substituir o aconselhamento, diagnóstico ou tratamento médico profissional. Se necessitar de tratamento médico, procure sempre o conselho do seu médico ou dirija-se ao serviço de urgência mais próximo. As opiniões, crenças e pontos de vista expressos pelos indivíduos no conteúdo encontrado nesta página não reflectem as opiniões, crenças e pontos de vista da OrthoEvidence.
0 de 4 artigos mensais GRATUITOS desbloqueados
