Comparative study of internal and hybrid external fixation in tibial condylar fractures

The spectrum of injuries to the tibial plateau is so great that no single method of treatment has been proven to be uniformly successful. The purposes of this study were to evaluate the clinical results, to identify the advantages and disadvantages and to take out useful conclusions of the application of the internal and hybrid external fixation in the treatment of these fractures.

Sixty tibial condylar fractures, of all types, according to Schatzker's classification were treated with open reduction and internal fixation (30 patients) or with hybrid external fixation (30 patients). The following parameters were recorded: time of surgical procedure, time of postoperative hospitalization, time of starting of weight bearing on the affected extremity, complications, and postoperative functional (according to Knee Society Score) and radiological results (according to Rasmussen's Radiological Score). The average time of follow-up was 12 months.

Neither of the two methods showed superiority regarding the duration of the surgical procedure [mean difference 4.4 ± 5.4 (min), P = NS], the postoperative hospitalization time [0.6 ± 0.7 (days), P = NS], and the radiological and functional evaluation (χ(2), P = NS for all comparisons). However, the internal fixation method proved to be superior to the hybrid external fixation regarding the time of starting the weight bearing [3.1 ± 0.4 (weeks), P < 0.001].

Internal fixation showed superiority to the time starting of weight bearing as it occurred at an earlier time than that of hybrid external by almost 3 weeks whereas no other differences were identified in the other parameters regarding patients' rehabilitation.