Timing of open reduction and internal fixation for acute pilon fractures in adults: Early versus delayed — A systematic review and meta-analysis
Yang Chen, Huan Liu, Yongzhong Cheng, Haibin Sun, Chaolu Wang, Chaoyue Zhao, Rui LiObjective
To compare the safety, clinical outcomes, and healthcare resource utilization associated with early versus delayed definitive fixation for acute pilon fractures through a systematic review and meta-analysis.
Method
Systematic review and meta-analysis. PubMed, Cochrane Library, Embase, Web of Science, CNKI, SinoMed, VIP Database, and Wanfang Data were searched. Eligibility criteria for study selection: Randomized controlled trials and comparative observational studies reporting early versus delayed definitive fixation in adult patients with pilon fractures were included. Data synthesis: The primary outcome was major soft-tissue complications. Secondary outcomes included minor soft-tissue complications, fracture union time, fracture healing complications, quality of reduction, ankle function, and length of hospital stay. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the I 2 , chi-square, and τ 2 statistics.
Results
A total of 21 studies involving 2,600 fractures were included. No significant difference was observed in major soft-tissue complications between early and delayed definitive fixation (OR,1.01 [95%CI, 0.57 to 1.79]). Early fixation was associated with a significantly shorter hospital stay (MD, -7.91 [95%CI,-10.71 to -5.10]). No significant differences were identified in minor soft-tissue complications, fracture healing complications, reduction quality, or ankle function.
Conclusions
Early definitive fixation for pilon fractures does not appear to increase the risk of soft-tissue complications when patients are carefully selected based on soft-tissue condition. Early intervention may reduce hospital stay and improve healthcare efficiency. These findings support an individualized, soft-tissue–driven approach to surgical timing rather than arbitrary time thresholds in pilon fractures, although standardization of soft-tissue assessment criteria based on high-quality randomized trials remains necessary.