Early Outcome of Hybrid External Fixation for Fracture of the Distal Tibia

OBJECTIVE: To evaluate the early results of treatment when using hybrid external fixation for fractures of the tibial plafond. DESIGN: Retrospective review of patients treated according to protocol. Patients treated with the hybrid fixator were compared with patients treated with open reduction and internal fixation. SETTING: Orthopaedic trauma service of a Level I trauma center, with a single surgeon directing care. PATIENTS/PARTICIPANTS: All patients with fractures of the distal tibia during a five-year period (n = 63) were treated according to protocol, with specific criteria determining method of treatment. Eleven patients were lost to follow-up, and three additional patients were not reviewed for other reasons. Follow-up period averaged twenty months. INTERVENTION: Fracture stabilization was accomplished with the use of a hybrid external fixator (n = 34) or with internal fixation (n = 27), as determined by patient or fracture criteria. Two patients did not receive planned treatment. MAIN OUTCOME MEASUREMENTS: Range of motion, clinical ankle score, and incidence of complications. RESULTS: Patients treated with hybrid fixation had lower clinical scores, slower return to function, a higher rate of complications, more nonunions and malunions, and more infections. CONCLUSIONS: Due to differences in patient populations, the superiority of either treatment method is uncertain; however, hybrid fixation did not seem to solve the problems inherent in severe pilon fractures. The sanguine results reported in the literature did not hold true in this group.