USE OF AN ARTICULATED EXTERNAL FIXATOR FOR FRACTURES OF THE TIBIAL PLAFOND

We performed a prospective study of forty-nine displaced fractures of the tibial plafond in forty-eight patients managed, at three centers, with an articulated external fixator placed medially across the ankle joint. Forty ankles had interfragmental screw fixation of a reduced ar ticular fracture, and fourteen ankles had bone-grafting. The average d uration of external fixation was twelve weeks. All of the fractures he aled (one after delayed bone-grafting). There were no infections in an y of the operative or traumatic wounds over the tibia, Two wound infec tions over the fibula resolved with treatment, Eight patients were man aged with antibiotics for a pin-site infection, and two patients had c urettage and debridement of a pin site in the hindfoot after removal o f the fixator. Thirty patients (thirty-one ankles) completed two-year data sheets at an average of thirty months after the injury. The avera ge ankle score was 67 points. Twenty-one patients had grade-0 or 1 ost eoarthrosis and nine had grade-2 or 3. One ankle had been treated with an arthrodesis. These data suggest that the prevalence of early compl ications associated with severe fractures of the tibial plafond and th eir treatment can be decreased with use of an articulated external fix ator combined with limited internal fixation, We concluded that this t echnique of external fixation is a satisfactory technique for the trea tment of these fractures.