External Fixation Versus ORIF for Distal Intra-articular Tibia Fractures

Abstract

Tibia plafond fractures have historically demonstrated high complication rates. The purpose of this study was to assess the outcomes of tibia plafond fractures following treatment with definitive external fixation vs delayed open reduction and internal fixation (ORIF). Sixty patients were enrolled in a prospective cohort trial at 1 Level I trauma center. No differences were noted between the 2 treatment groups in terms of age, smoking history, presence of comorbidities, mechanism of injury, incidence of open fractures, or Orthopaedic Trauma Association fracture classification. Complete 12-month follow-up was available for 18 patients in the definitive external fixation group and 27 patients in the ORIF group. No difference was noted in articular reduction between the groups at 6 and 12 months postoperatively. Delayed union or non-union occurred in 4 (22.2%) of 18 patients in the external fixation group and 1 (3.7%) of 27 patients in the ORIF group (P=.05). Deep infection was equally likely in either group (P=.33). The ORIF group had improved Iowa Ankle Scores at 6 (23.6 ± 12.1 vs 11.1 ± 7.7; P<.05) and 12 months (5.5 ± 2.2 vs 3.1 ± 1.7; P<.05) postopertively and improved Short Form-36 Physical Function scores at 6 months (49.7 ± 30.1 vs 25.5 ± 8.0; P<.05) postoperatively compared with the external fixation group.External fixation and ORIF can attain bony union with adequate articular reduction and similar infection rates. Patients treated with ORIF appeared to have improved union rates and early outcomes with ankle function and Short Form-36 Physical Function scores.

Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures

“…15 A total of 3 studies involving 141 fractures reported the results of delayed union. The rate of delayed union was 5 of 78 fractures in the two-stage ORIF group and 9 of 63 fractures in the LIFEF group.…”

External fixation versus open reduction and internal fixation of pilon fractures: A systematic review and meta-analysis

“…[31,32] The assessment of the included cohort studies suggests that two studies [20,30] had unbalanced prognostic factors of the patients in their cohorts as they did not match patients in the design nor did they adjust for important compounding factors, in contrast to the rest of the cohort studies. In addition, the studies of Anglen [20] Davidovitch et al, [27] Guo et al, [29] and Richards et al [28] did not have an adequate follow-up with >20% of their patients lost to follow-up. The included RCTs [19,26] carried a high risk of bias, especially in blinding and concealment of patients and outcomes.…”

Clinical efficacy and safety of limited internal fixation combined with external fixation for Pilon fracture: A systematic review and meta-analysis

“…Nine articles directly comparing LIFEF and ORIF for the treatment of pilon fracture were included in this meta-analysis, including one randomized controlled trial (RCT), 19 one cohort study 12 and 7 retrospective studies 15, 20, 21, 22, 23, 24, 25. Totally 498 fractures in 494 patients were included in this study, and all eligible patients were followed up for at least 12 months.…”

“…Because ORIF can restore the anatomic structure of distal tibia, it has been regarded as a safe surgical procedure with good results. However, the extensive dissection of soft tissue might lead to increased complications, such as infection, skin necrosis, tensity wheal and other complications 11, 12, 13, 14. LIFEF has been widely used for pilon fracture in recent years, but results in poor restoration of articular surface and high rates of traumatic arthritis 15, 16, 17.…”