Table 2.
Demographic profiles of the included studies
| Study | Study design | No. of fracture (no of patients) | Age (range) in years |
Gender (M: F) | Associated injuries (%) | Obesity, smoking & comorbidities (%) | Fracture type | Intervention | Meantime to surgery | Mean follow-up (range) in months | mCCS |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Sanders 1991, USA | Retrospective study | 9 | 39.4 | 3:6 | – | – |
GA classification Closed:4 Open:5 (Gr II:2, Grade III:3) Muller's classification Type C2.3: 4 Type C3.3: 5 |
Condylar buttress plate on the lateral side and one medial plate | – | 26 (21–34) | 51 |
| Chapman 1999, USA | Retrospective study | 13 | 45.6 (25–81) | 5:8 | – | – |
GA classification Closed; 2 Open; 8 ( Gr IIIA: 7, IIIC: 1) Osteotomy: 3 Muller's classification Type A1: 1 Type A2; 1 Type A3: 2 Type C2: 3 Type C3: 1 Unknown/NA: 5 |
Lateral plate: 95° DCS/dome plunger screw 7, Condylar buttress plate 4, DCP/Alta broad plate 2 Anteromedial plate: DCP/Alta side plate in all |
15 (5–36 mo) | 28.38 (6–120) | 50 |
| Ziran et al. 2002, USA | Retrospective study | 36 (35 pts) | – | 21:14 | – | – |
GA classification Closed: 24 Open: 12 (Gr I: 4, Gr IIIA: 5, Gr IIIB: 1, Gr IIIC: 2) Muller's classification C2: 16 C3: 19 (two died, one lost to fu, two developed infection-one amputation) |
Lateral: blade plate 18, condylar plate 18 Anteriorly: reconstruction plate 10, DC plate 25 |
– | 7.7 (3–44) | 54 |
| Khalil 2012, Egypt | Prospective study | 12 | 33.5 (22–44) | 8:4 |
Minor head injuries– 5 (41.7%) Chest injuries –10 (83.3%) Abdominal injuries– 7 (58.3%) Upper limb injuries– 4 (33.4%) Ipsilateral lower limb injuries– 2 (16.7%) Contralateral lower limb injuries –4 (33.40%) Stable pelvic fractures– 5 (41.7%) Stable spinal fractures 3 (25%) Knee derangement–5 (41.7%) |
Overweight 5 (41.6%), Obese 2 (16.6%) Heavy smokers 5 (41.6%) |
GA classification Closed: 12 Muller's classification C3:12 Associated Hoffa: 7 (lateral 4, medial 3) |
Lateral: locked plate Medial: Contoured medial plate (reconstruction plate in 8, semitubular plate in 4) |
First week:8 2 wks:4 |
13.7 (11–18) | 54 |
| Dugan 2013, USA | Retrospective study | 15 (14 pts) | 41 (16–75) | 8:7 | All pts had multisystem injury (ISS ≥ 16) | – |
GA classification: All open fracture Grade IIIA: 10 Grade IIIB: 5 AO classification: Type C2: 7 Type C3: 8 |
1st stage: debridement + lateral locked plate + antibiotic beads 2nd stage: removal of beads and application of medial plate (small fragment combi-holes) + bone grafting/bone graft substitute |
1st stage: < 24 h Second stage: 3.6 mo (1–6 mo) |
Till radiographic union (4mo) | 46 |
| Holzman 2016, USA | Retrospective study | 23 (22 pts) | 58 (35–83) | 6:16 | – |
Obese 6 (27%) Smoker 7 (43.75%) Hypertension 11 (50%) Stroke 2 (9%) COPD 2 (9%) CVD 4 (18%) Mood disorder 7 (32%) Type 2 DM 2 (9%) Asthma 4 (18%) Osteoarthritis 5 (23%) Infected fracture site 1 (4.5%) Multiple myeloma 1 (4.5%) |
23 nonunion: atrophic 21 oligotrophic 2 (well-fixed, stable lateral locking plate with a satisfactory soft tissue envelope: 16 Failed lateral plate: 7 GA classification (initial injury) Closed 14 (13 pts) Open 8 |
Lateral: locked plate (previous fixed stable plate 16, revision of plate 7), Medial: medial locked plate |
16 mo | Median 18 (6–94) | 46 |
| Steinberg 2017, Israel | Retrospective study | 32 | 76 (44–101) | 6:26 | – | – |
22 acute fracture, 2 nonunion, 8 periprosthetic fracture GA classification Closed 33 Open 1 Muller's classification (24) Type A2: 1, Type A2: 2, Type A3: 7, Type C1: 4, Type C2: 7, Type C3: 3 Rorabeck-Taylor classification (8) Type 1: 1, Type 2: 7 |
Lateral locked plate and medial locked/LCDCP | 3.8 days (range, 0–11 days) | 12 | 58 |
| Imam 2017, Egypt | Prospective study | 16 | 36 ± 12.4 (18–59) | 11:5 |
Pelvic fracture 1 (6.25%) Cervical fracture 1 (6.25%) |
Overweight/obese 6 (37.5%) Smokers 7 (43.75%) Diabetes mellitus 2 (12.50%) Chronic liver disease 2 (12.50%) Hypertension 3 (18.75%) |
Muller’s/OTA classification Type C3: 16 |
Lateral locked plate with a low-contact-locked medial plate |
– | 11.5 ± 4.7 (6–24) | 60 |
| Bai 2018, China | Prospective study |
Total 60 (58 pts) Single plate: 48 Dual plate: 12 |
Single plate: ≤ 30 y: 8 (16.7%) 31–40 y: 8 (16.7%) 41–50 y: 10 (20.8%) ≥ 51 y: 22 (45.8%) Dual plate: ≤ 30 y: 1 (8.3%) 31–40 y: 4 (33.3%) 41–50 y: 4 (33.3%) ≥ 51 y: 3 (25.0%) |
Single plate-23:25 Dual plate–6:6 |
Single plate: 1 extra-location fracture 10 (20.8%) > 2 extra locations fracture 13 (27.1%) Double plate: 1 extra location fracture 2 (16.7%) > 2 extra locations fracture 0 |
– |
GA classification Single plate: Closed 23 (48.0%) Open Gr I: 9 (18.8%) Gr II: 11 (22.9%) Gr III: 5 (10.4%) Vascular injury 2 Combined external fixator: 7 Dual plate: Closed 1 (8.3%) Gr I: 5 (41.7%) Gr II: 5 (41.7%) Gr III: 1 (8.3%) Combined external fixator: 1 |
Single plate: Lateral locked plate Dual plate: lateral locked plate and medial anatomical plate or upper limb compression plate |
Single plate: 11 d Dual plate: 12 d |
15.9 | 73 |
|
Muller's/ AO-OTA classification Single plate: Type-A: 16 Type-B: 6 Type-C:26 Dual plate: Type-A: 0 Type-B: 0 Type-C: 12 |
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| Metwaly 2018, Egypt | Prospective cohort study | 23 | 69.6 (61–80) | 4:19 | Polytrauma excluded |
Smokers-2 (8.69%) DM- 15 (65.21%) ISHD on clopidogrel -7 (30.4%) COPD- 2 (8.69%) CLD- 5 (21.7%) |
AO-OTA Type 33-A3: 3 Type 33-C1: 2 Type 33-C2: 13 Type 33-C3: 5 |
Lateral and medial locked plate | 5 days | 14.1 | 64 |
| Zhang 2018, China | Prospective randomized study |
32 (fu of 29 pts, 3 lost to fu) Single plate 15, dual plate 14 |
Single plate: 57.93 ± 13.60 Dual plate: 59.07 ± 14.58 |
10:19 | Polytrauma excluded | NM |
Single plate Type A2/A3- 6 /9 Double plate Type A2/A3-5 /9 |
Single plate: 15 (lateral locked plate) Dual plate: 14 (lateral locking plate with medial DCP) |
– | 12 mo (29 pts, one from single plate and 2 from dual plate lost to fu) | 73 |
| Bologna 2019,USA | Retrospective study |
Total 21 Single plate 13, Dual plate 8 |
61 Single plate 54 (46–76) Dual plate 66.5 (55–78) |
2:19 | – |
Single plate: BMI 27.0 (24–30) Tobacco 5 (38%) DM 2 (15.4%) Dual plate: BMI 29.5 (28.5–32) Tobacco 3 (37.5%) DM 2 (25%)) |
GA classification Open 5 (single plate 4, dual plate 1) Muller's / AO-OTA classification: 33-C2: 7 (single plate 4,dual plate 3) 33-C3: 7 (single plate 5, dual plate 2) Periprosthetic fractures-7 (single plate 4, dual plate 3) |
Single plate 13 (lateral locked plate) Dual plate 8 (Lateral and medial locked plate) |
– |
12 (6–29) Single plate: 8 (6–15) Dual: 13 (11–22) |
46 |
Pts patients, Fu follow-up, GA Gustillo–Anderson Classification, CLD chronic liver disease, COPD chronic obstructive pulmonary disease, DM diabetes mellitus, ISHD ischemic heart disease, BMI body mass index, DCP dynamic compression plate, LCDCP low-contact dynamic compression plate