Pigeolet Manon, Sana Hamaiyal, Askew Morgan R, Jaswal Shubham, Ortega Paola F, Bradley Sarah R, Shah Ayush, Mita Carol, Corlew Daniel S, Saeed Ayesha, Makasa Emmanuel, Agarwal-Harding Kiran J
Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts, USA.
Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
Bone Jt Open. 2024 Nov 11;5(11):1020-1026. doi: 10.1302/2633-1462.511.BJO-2024-0163.
Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation.
This systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available.
The lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care.
下肢骨折在低收入和中等收入国家（LMICs）很常见，对现有的骨科手术基础设施构成重大负担。在高收入国家（HIC）环境中，由于其更好的治疗效果，内固定是标准的治疗方法。在LMICs中，由于供应有限、成本考虑以及其较低的并发症发生率，外固定通常是首选的手术治疗方法。本系统评价方案的目的是确定在LMICs中，采用内固定或外固定治疗的关节外股骨和胫骨干骨折的感染率、骨不连率和畸形愈合率的差异。
本系统评价方案描述了对多个数据库的广泛检索，以识别符合条件的论文。研究必须在2000年以后发表，包括至少五名患者，患者年龄必须>16岁或被视为骨骼成熟，并且论文必须描述感兴趣的骨折以及我们至少一项感兴趣的主要结局。我们没有对语言或期刊进行限制。所有摘要和全文将由两名独立的评审员进行筛选和提取。将使用标准化评估工具分析偏倚风险和证据质量。如果有足够的数据，将进行随机效应荟萃分析，然后进行亚组分析，因为预计研究之间存在异质性。
缺乏易于获取的LMICs结局数据，再加上通常由HIC外科医生制定的、用于HIC环境的国际临床指南，使得LMICs的外科医生在临床决策过程中面临更大的困难。本方案将指导对LMICs下肢骨干骨折的手术管理、结局和并发症的研究，并有助于指导政策制定，以提供更好的手术干预并改善全球外科护理。
