Plates versus external fixation in severe open tibial shaft fractures. A randomized trial

A prospective study of 59 patients with Grade II or III open tibial shaft fractures compared internal and external fixation. Bony stabilization was with plating by AO principles or with external fixation with the one-half pin technique, prospectively randomized. In 12 cases, minimal internal fixation of the tibia and external fixation were combined. Definitive wound closure was delayed in all cases. Three free-flap transfers and two gastrocnemius myoplasties were done; vascular injury necessitated three early limb amputations. Fifty-six patients were followed for at least one year. Five plate fixations (19%) were complicated by severe osteomyelitis, and three plate fixations failed. Severe osteomyelitis occurred in one case (3%) treated with external fixation. Three pin-tract infections occurred. In two patients, a 10 degrees anteroposterior angulation occurred after external fixation removal. One patient healed with a 25 degrees external rotation deformity. At final follow-up evaluation, all tibial shaft fractures had healed. Knee and ankle ranges of motion were affected by ipsilateral femoral shaft fracture, knee injury, or ankle and foot trauma but not by the type of fixation. Both methods yielded excellent results, but the rate and extent of complications were lower with external fixation. Therefore, external fixation using the one-half pin technique should be regarded as a primary method of stabilization for Grades II and III open tibial shaft fractures.