title: Use of an articulated external fixator for fractures of the tibial plafond.
abstract: We performed a prospective study of forty-nine displaced fractures of the tibial plafond in forty-eight patients managed, at three centers, with an articulated external fixator placed medially across the ankle joint. Forty ankles had interfragmental screw fixation of a reduced articular fracture, and fourteen ankles had bone-grafting. The average duration of external fixation was twelve weeks. All of the fractures healed (one after delayed bone-grafting). There were no infections in any of the operative or traumatic wounds over the tibia. Two wound infections over the fibula resolved with treatment. Eight patients were managed with antibiotics for a pin-site infection, and two patients had curettage and débridement of a pin site in the hindfoot after removal of the fixator. Thirty patients (thirty-one ankles) completed two-year data sheets at an average of thirty months after the injury. The average ankle score was 67 points. Twenty-one patients had grade-0 or 1 osteoarthrosis and nine had grade-2 or 3. One ankle had been treated with an arthrodesis. These data suggest that the prevalence of early complications associated with severe fractures of the tibial plafond and their treatment can be decreased with use of an articulated external fixator combined with limited internal fixation. We concluded that this technique of external fixation is a satisfactory technique for the treatment of these fractures.
authors.affiliation: Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Marsh
authors.forename: S
authors.initials: S
authors.lastname: Bonar
authors.forename: J V
authors.initials: JV
authors.lastname: Nepola
authors.forename: T A
authors.initials: TA
authors.lastname: Decoster
authors.forename: S R
authors.initials: SR
authors.lastname: Hurwitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery; D000843:Ankle Joint / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000601:surgery; D001863:Bone Screws / Q000009:adverse effects; D016025:Bone Transplantation; D003475:Curettage; D004867:Equipment Design; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology; D011446:Prospective Studies; D013978:Tibial Fractures / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents