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

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Abstract

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.

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