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

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To evaluate the early results of treatment when using hybrid external fixation for fractures of the tibial plafond.


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.


Orthopaedic trauma service of a Level I trauma center, with a single surgeon directing care.


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.


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.


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.


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.

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