ReviewMusculoskeletal surgery2026
Comparison between early versus delayed (staged) plate fixation in the treatment of pilon (tibial plafond) fractures: a systematic review and meta-analysis.
Review in Musculoskeletal surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
8 authors.
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Abstract
The optimal timing of definitive fixation for tibial plafond (pilon) fractures remains controversial. While staged protocols aim to reduce soft-tissue complications, early definitive fixation may reduce morbidity associated with prolonged external fixation. This systematic review and meta-analysis evaluated whether early fixation is associated with different complication rates compared with delayed or staged management. A systematic search of PubMed, Web of Science, Scopus, and the Cochrane Library was conducted from inception to December 2025. Comparative studies evaluating early versus delayed or staged surgical management of adult pilon fractures were included. Early management was defined as definitive plate fixation performed within 48-72 h after injury, while delayed or staged management involved initial external fixation followed by delayed definitive surgery. Primary outcomes were infection or wound complications and reoperation. Secondary outcomes included malunion and nonunion. Random-effects meta-analyses were performed using risk ratios (RR) with 95% confidence intervals (CI). Risk of bias was assessed using validated tools, and certainty of evidence was graded using GRADE. Reporting followed PRISMA 2020 guidelines. This review was not prospectively registered. Seven studies involving 543 patients were included. There was no significant difference in infection or wound complications between early and delayed or staged fixation (RR 0.83; 95% CI 0.41-1.69). No significant reduction in reoperation was observed with early fixation (RR 0.60; 95% CI 0.36-1.00). No significant differences were found for malunion (RR 0.92; 95% CI 0.24-3.54) or nonunion (RR 0.79; 95% CI 0.49-1.28). Overall certainty of evidence ranged from low to very low. Early definitive plate fixation appears to have comparable complication rates to delayed or staged protocols, with a possible reduction in reoperation. Selective early fixation may be safe in appropriately chosen patients.
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Registered trials
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