Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil; Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, Brazil.
Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil.
Injury. 2021 Jul;52 Suppl 3:S89-S96. doi: 10.1016/j.injury.2021.01.047. Epub 2021 Jun 1.
To provide a direct comparison between two important aspects related to talar neck fractures management - surgical approaches and fixation strategies.
A systematic review and meta-analysis was performed using PubMed, SciELO, and gray literature databases. The keyword "talus fracture" and the combined terms "talus neck fracture AND surgical approach" and "talus neck fracture AND fixation strategy" were used.
Study selection, data extraction, and the risk of bias assessment were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Searches were limited to human studies and the English and Portuguese. Inclusion criteria were articles in full text that reported on any aspect of surgical approach and fixation strategy for talus neck fractures. Exclusion criteria were skeletally immature patients, mean follow-up of less than 12 months, studies that did not use the Hawkins classification system, primary treatment of arthrodesis, studies published before year 2000, and studies published in languages other than English and Portuguese.
Basic information was collected including journal, author(s), year published, level of evidence, number of fractures, and follow-up. Specific information was collected including fracture classification, surgical approach, fixation strategy, complication rate, type of complication(s), and outcome measurement(s).
Fixed-effects model was used for meta-analysis. The choice for surgical approach(es) and fixation strategy was stratified based on fracture classification. Complication rate, type of complication(s), and outcome measurement(s) were calculated for all studies and delineated by fracture classification.
There is a significant correlation between poor scores and poor fracture reduction, but not with the modified Hawkins classification, surgical approach, and fixation strategy. The presence of an open talus neck fracture-dislocation jeopardizes the functional outcome, increasing the risk of complications. The overall avascular necrosis and post-traumatic osteoarthritis event rate was 0.279 and 0.400, respectively. Both complications were highly correlated to higher energy fracture patterns and to the use of combined approaches, but not to fixation strategy.
I (systematic review and meta-analysis).
提供与距骨颈骨折管理相关的两个重要方面的直接比较 - 手术入路和固定策略。
使用 PubMed、SciELO 和灰色文献数据库进行了系统评价和荟萃分析。使用了关键词“距骨骨折”和联合术语“距骨颈骨折和手术入路”和“距骨颈骨折和固定策略”。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行研究选择、数据提取和偏倚风险评估。搜索仅限于人类研究和英语和葡萄牙语。纳入标准是报告距骨颈骨折手术入路和固定策略任何方面的全文文章。排除标准是骨骼未成熟患者、随访时间少于 12 个月、未使用 Hawkins 分类系统、初次治疗为融合术、2000 年前发表的研究以及发表语言不是英语和葡萄牙语的研究。
收集了基本信息，包括期刊、作者、发表年份、证据水平、骨折数量和随访。收集了特定信息，包括骨折分类、手术入路、固定策略、并发症发生率、并发症类型和结果测量。
使用固定效应模型进行荟萃分析。根据骨折分类对手术入路和固定策略的选择进行分层。计算了所有研究的并发症发生率、并发症类型和结果测量，并按骨折分类进行了划分。
评分不佳与骨折复位不佳之间存在显著相关性，但与改良 Hawkins 分类、手术入路和固定策略无关。开放性距骨颈骨折脱位的存在危及功能结局，增加并发症风险。总的缺血性坏死和创伤后骨关节炎发生率分别为 0.279 和 0.400。这两种并发症都与较高能量的骨折模式和联合入路的使用高度相关，但与固定策略无关。
I（系统评价和荟萃分析）。
