Hybrid external fixation in tibial plafond fractures

Fourteen patients with Ruedi/Allgower types II and III distal tibia fractures received indirect reduction followed by application of a Monticelli-Spinelli hybrid external fixation system. All 14 patients were available for followup. A stability similar to that of an open reduction and internal Fixation was noted. The mean time to union was 13 weeks. There were no nonunions. One patient experienced malunion in 7 degrees varus. Superficial pin tract infections occurred in 8 pins (3 patients), and all resolved with aggressive pin care and a short course of orally administered antibiotics. Through postoperative tomography, 1 pin was found to be within the ankle joint and was removed. There were no deep infections. The subjective and objective results were classified according to Ovadia and Beals. On the basis of these early results, by limiting additional trauma to the soft and bony tissues and allowing early ankle range of motion, indirect reduction and application of a hybrid external fixator is useful, particularly if the fracture fragments are so comminuted that anatomic reduction cannot be expected despite surgical intervention.