Comparative evaluation of internal versus external fixation of fractures of the tibial plafond

BackgroundWe carried out a randomized, retrospective study to compare the results of two methods for the operative fixation of fractures of the tibial plafond. In the first group, which included 18 patients, open reduction and internal fixation of both the tibia and the fibula was performed through two separate incisions. An additional patient, who had an intact fibula, underwent fixation of the tibia only through an anteromedial incision. The second group included 20 patients who were managed with external fixation with or without limited internal fixation (a fibular plate or tibial interfragmentary screws).Patients and methodsTen (26%) of the 39 fractures were open and 17 (44%) were type III according to the classification of Rüedi and Allgower. There were 15 operative complications in seven patients who had been managed with open reduction and internal fixation and four complications in four patients who had been managed with external fixation. All except four of the complications were infection or dehiscence of the wound that had developed within 4 months after the initial operation.ResultsAt a minimum of 2 years postoperatively (average 39 months; range 25-51 months), the average clinical score was lower for the patients who had a type II or type III fracture, irrespective of the type of treatment. With the numbers available, no significant difference was found between the average clinical scores for the two groups. All of the patients, in both groups, who had had a type II or a type III fracture had some degree of osteoarthrosis on plain radiographs at the time of the latest follow-up.ConclusionExternal fixation is a satisfactory method of treatment for fractures of the tibial plafond and is associated with fewer complications than internal fixation, especially in open fractures.