The Journal of Bone and Joint Surgery 78:1646-57 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.
Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study*
BRAD WYRSCH, M.D. ,
MARK A. MCFERRAN, M.D. ,
MARK MCANDREW, M.D.,
THOMAS J. LIMBIRD, M.D.,
MARION C. HARPER, M.D.,
KENNETH D. JOHNSON, M.D. and
HERBERT S. SCHWARTZ, M.D., NASHVILLE, TENNESSEE
Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville
We performed a randomized, prospective study to compare the results of two methods for the operative fixation of fractures of the tibial plafond. Surgeons were assigned to a group on the basis of the operation that they preferred (randomized-surgeon design). In the first group, which consisted of eighteen 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, had fixation of the tibia only through an anteromedial incision. The second group consisted of twenty patients who were managed with external fixation with or without limited internal fixation (a fibular plate or tibial interfragmentary screws). Ten (26 per cent) of the thirty-nine fractures were open, and seventeen (44 per cent) were type III according to the classification of Rüedi and Allgöwer.
There were fifteen 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 but four of the complications were infection or dehiscence of the wound that had developed within four months after the initial operation. The complications after open reduction and internal fixation tended to be more severe, and amputation was eventually done in three patients in this group.
At a minimum of two years postoperatively (average, thirty-nine months; range, twenty-five to fifty-one months), the average clinical score was lower for the patients who had had a type-II or III fracture, regardless 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 III fracture had some degree of osteoarthrosis on plain radiographs at the time of the latest follow-up. With the numbers available, there was no significant difference between the two groups with regard to the osteoarthrotic changes.
We concluded that external fixation is a satisfactory method of treatment for fractures of the tibial plafond and is associated with fewer complications than internal fixation.
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