Comparative analysis of different incision ways of posterior approach for posterior tibial plateau fractures: a systemic review and meta-analysis.

Abstract

Inadequate treatment of posterior tibial plateau fractures can cause instability, yet no agreement exists regarding the optimal surgical approach for achieving favorable outcomes. Hence, the aim of this study is to assess and compare the postoperative outcomes of different posterior surgical techniques, including reverse L-shape, S-shaped, posterior medial, extended posterolateral, and posterolateral prone approaches. To evaluate the efficacy of surgical approaches, we searched databases such as PubMed, Embase, Web of Science, The Cochrane Library, and Scopus. Studies published before October 26th, 2022 were included, and we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The study's outcomes comprised complications, infections, range of motion (ROM), operation time, and functional scores, and p-values <0.05 were considered significant. To conduct the meta-analysis, we utilized the R software. We included 8 studies with 104 patients. The extended posterolateral approach reduced incidence of complications and improved ROM, while the posterolateral prone approach reduced ROM. Conversely, the S-shaped approach was linked to lower HSS scores. No significant differences were found in infection rates or operative time among the various surgical approaches. The extended posterolateral approach was associated with a lower incidence of complications and greater ROM compared to other surgical approaches. In contrast, the S-shaped approach was linked to lower HSS scores, and the posterolateral prone approach was associated with reduced ROM. These findings suggest that further prospective studies are necessary to establish the optimal surgical approach for posterior tibial plateau fractures.