Bridge Plating Versus Hybrid External Fixation in the Management of Proximal Tibia Metaphyseal Fractures

Due to the surge in high-speed road traffic accidents during the past few years, extra-articular proximal tibia fractures have also risen in number. For the treatment of such fractures, various options are available like conservative treatment with casting, surgical treatment with plate osteosynthesis, or a hybrid external fixator. Exposure of the bone surface and extensive soft tissue dissection is needed in bridge plating, posing a risk of bleeding, infection, and soft-tissue healing issues, and the blood supply of the fractured area is also hampered as the periosteum is also destroyed. To avoid these complications, a hybrid external fixator can be used but it has its own risks of malunion, non-union, and pin-tract infections; another drawback is patient compliance. In this study, we compare the clinical and functional outcomes of two treatment modalities, i.e., bridge plating and hybrid external fixator, in the treatment of proximal tibia metaphyseal fractures.

This prospective randomized study was conducted from February 2021 to June 2022 on 46 adult patients diagnosed with proximal tibia metaphyseal fracture and willing to participate. An odd number of patients were treated with a bridge plate and even with a hybrid external fixator.

A total of 46 patients were included in the study, sustaining proximal tibia metaphyseal fracture, out of which 23 patients underwent hybrid external fixation with an outcome of 69.43 ± 8.11 according to the Knee Society Score (KSS) and 23 for bridge plating which showed better results as their score at final follow-up was 75.00 ± 8.22.

According to our study, we found that bridge plating is a better treatment modality than the hybrid external fixator as the former showed better postoperative knee range of motion and functional outcome and led to a smaller number of complications. But the clinical outcome would also be influenced by the type of fracture, degree of comminution, type of injury, i.e., open or closed, and quality of bone.