Management of comminuted closed tibial plafond fractures using circular external fixators

Various types of external fixators have been used to treat Ruedi and Allgöwer Type III pilon fractures, as serious complications can occur using conventional treatment principles. However, insufficient reduction and loss of reduction are two of the main disadvantages of external fixator treatments. We conducted a retrospective review of 14 patients with severe highly comminuted closed fractures of the distal tibia (Ruedi type III) treated using cross-ankle external fixators. Five patients underwent closed reduction, while the others required open reduction using minimal incision techniques. The reduction score, reduction loss, early and late complications, and ankle symptoms and functions were evaluated. The patients were followed for an average of 48 months (range: 31 to 84); superficial wound infection developed in one case and minimal angular deformity in another. In ten cases, the reduction of the articular surface was anatomical; in the other four cases, it was non-anatomical. Except for one case which developed an angular deformity, no loss of reduction was observed. On radiological control, only one case did not display osteoarthrosis; in the other 13 cases, osteoarthrosis was diagnosed at different levels. The most important disadvantage of this technique is retarded joint movement. Nevertheless, for such fractures, we consider cross-ankle circular external fixators as an alternative treatment method because it combines the advantage of a minimal risk of deep infections with better stabilisation of the limb, while providing early mobilisation.