Plating fixation or ring fixation compression during a masquelet technique for tibial fracture patients: a systematic review and meta-analysis

Purpose
The purpose of this study is to compare the outcomes of using a ring fixator compression or plating fixation in tibial shaft fracture patients treated with the Masquelet technique.
Methods
The author conducted a search of the literature for studies that compared the use of a ring fixator or plate for the Masquelet technique in patients with tibial shaft fractures. All full English only articles in the form of randomized and nonrandomized studies were included. Search engines used included PubMed/Medline, Scopus, Cochrane, Web of Science, Embase, Google scholar, Science Direct, and Clinicaltrials.gov.
Results
The results demonstrate that, patients who underwent the plating fixation with Masquelet technique had greater risks of developing superficial surgical site infections (P < 0.001), stiffness/decreased range of motion (P <0.001), wound and soft tissue disclosure (P = 0.026), postoperative fractures (P < 0.001), and had overall greater risk for postoperative failure (P = 0.003) in comparison to the ring fixation compression with Masquelet technique. In terms of deep surgical site infections, there was no significant difference between the two techniques. The results of this study would therefore suggest that the ring fixation compression with Masquelet technique is a greater alternative to the plating fixation with Masquelet technique for tibial shaft fracture patients.
Conclusion
Plating fixation with Masquelet technique had significantly higher rates of superficial surgical site infection, operation failure, refracture, stiffness with decreased range of motion, wound and soft tissue disclosure than ring fixation compression. This would suggest that ring fixation compression with Masquelet technique is a better alternative to repairing tibial fractures than plating fixation with Masquelet technique.