873 Fixation and Graft Augmentation of Tibial Plateau Fractures: A Systematic Review and Meta-Analysis

Abstract

Abstract Aim Modern techniques have challenged the consensus of open reduction and internal fixation (ORIF) with autologous graft augmentation as the gold standard management of tibial plateau fractures. The objective of this review was to assess the outcomes of surgical techniques and graft materials for managing tibial plateau fractures. Method MEDLINE, Embase and CENTRAL searches were conducted alongside trial registers, conference abstracts and OpenGrey from their inception to July 2022. Randomized and quasi-randomized controlled trials comparing fixation techniques or graft materials were included. Bias was assessed using the Risk of Bias 2 (ROB2) framework, and certainty of evidence using the GRADE approach. Primary outcomes included functional and radiographic outcome scores, with secondary outcomes of complications, radiographic parameters, and time to union. Results Eleven studies were included, five assessing surgical techniques and 6 graft materials. ROB2 assessments highlighted some concerns in nine papers and high risk in one. Improved functional outcomes were reported in minimally invasive techniques (mean difference = 3.25, 95% CI -0.17, 6.67) trending towards significance (p = 0.20). Trends towards significantly reduced complications were observed in both minimally invasive (risk ratio 0.58, 95% CI 0.26, 1.30, p = 0.19) and synthetic graft (risk ratio 0.66, 95% CI 0.37, 1.15, p = 0.14) groups. sd definite conclusions regarding the best fixation and graft approach. However, greater efficacy and non-inferiority were demonstrated with minimally invasive techniques and synthetic grafts respectively. It is our judgement that the fixation approach is the most important prognostic factor in these injuries thus future research should be focused accordingly.