Heifner John J, Davis Ty A, Rowland Robert J, Gomez Osmanny, Gray Robert R L
Miami Orthopaedic Research Foundation, Miami, FL, USA.
Larkin Hospital Department of Orthopaedics, Coral Gables, FL, USA.
JSES Rev Rep Tech. 2024 Jan 18;4(2):196-203. doi: 10.1016/j.xrrt.2023.12.004. eCollection 2024 May.
Despite surgical reestablishment of the supporting structures, instability may often persist in traumatic elbow injury. In these cases, a temporary internal or external fixator may be indicated to unload the repaired structures and maintain joint concentricity. Aggregate data are needed to characterize the risk of complication between external fixation (ExFix) and the internal joint stabilizer (IJS) when used for traumatic elbow instability. Our objective was to review the literature to compare the complication profile between external fixation and the IJS.
A database query was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Population, Intervention, Comparison and Outcome characteristics for eligibility were the following: for patients over 18 years clinical outcomes were compared between an ExFix or the IJS for acute or chronic elbow instability. The Cochran risk of bias in nonrandomized studies of interventions and grades of recommendation, assessment, development, and evaluation framework were compiled for risk of bias and quality assessment.
The rate of recurrent instability was 4.1% in the IJS group (N = 171) and 7.0% in the ExFix group (N = 435), with an odds ratio of 1.93 (95% confidence interval 0.88-4.23). The rate of device failure was 4.4% in the IJS group and 4.1% in the ExFix group. Pin-related complications occurred in 14.6% of ExFix cases. Complications in the IJS group were the following: 1 case of inflammatory reaction, 4 cases of post removal surgical site infection, and 5 symptomatic removals.
The literature demonstrates a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability. Although not statistically significant, the higher rate of recurrent instability following external fixation may be clinically important. The high rate of pin-related complications with external fixation is notable.
尽管通过手术重建了支撑结构，但创伤性肘关节损伤后仍常出现不稳定。在这些情况下，可能需要使用临时内固定器或外固定器来减轻修复结构的负荷并维持关节同心度。需要汇总数据来描述外固定（ExFix）和内关节稳定器（IJS）用于创伤性肘关节不稳定时的并发症风险。我们的目的是回顾文献，比较外固定和IJS的并发症情况。
根据系统评价和Meta分析的首选报告项目指南进行数据库查询。纳入标准的人群、干预措施、对照和结局特征如下：对于18岁以上的患者，比较ExFix或IJS治疗急性或慢性肘关节不稳定的临床结局。对干预措施的非随机研究中的Cochrane偏倚风险以及推荐等级、评估、发展和评价框架进行汇总，以进行偏倚风险和质量评估。
IJS组（N = 171）的再发不稳定率为4.1%，ExFix组（N = 435）为7.0%，优势比为1.93（95%置信区间0.88 - 4.23）。IJS组的器械故障率为4.4%，ExFix组为4.1%。ExFix病例中有14.6%发生了与钢针相关的并发症。IJS组的并发症如下：1例炎症反应，4例取出后手术部位感染，5例有症状的取出。
文献表明，外固定和IJS作为创伤性肘关节不稳定的治疗方法时，并发症情况存在明显差异。尽管无统计学意义，但外固定后较高的再发不稳定率可能具有临床重要性。外固定与钢针相关的并发症发生率较高值得关注。
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