title: Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation.
abstract: BACKGROUND
  Tibial platfond fractures are usually associated with massive swelling of the foot and ankle, as well as with open wounds. This swelling may cause significant decrease of the blood flow, so the state of the soft tissue is determinant for the surgical indication and the type of implant. This retrospective study compares the union times in cases of tibial plafond fractures managed with a hybrid external fixation as a definitive procedure versus those managed with a two stage strategy with final plate fixation.
  
  
  METHODS
  A retrospective study in a polytrauma referral hospital was performed between 2005 and 2011. Patients with a tibial plafond fracture, managed with a hybrid external fixation as a definitive procedure or managed with a two stage strategy with the final plate fixation were included in the study. Postoperative radiographs were evaluated by two senior surgeons. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and anteroposterior X-ray. The clinical outcome was evaluated by means of 11 points Numerical Rating Scale for pain and The American Orthopedic Foot and Ankle Society ankle score, assessed at the last followup visit. Thirteen patients had been managed with a hybrid external fixation and 18 with a two-stage strategy with the final plate fixation. There were 14 males and 17 females with a mean age of 48 years (range 19-82 years). The mean followup was 24 months (range 24-70 months).
  
  
  RESULTS
  The mean time from surgery to weight bearing was 7 ± 6.36 days for the hybrid fixation group and 57.43 ± 15.46 days for the plate fixation group (P < 0.0001); and the mean time from fracture to radiological union was 133.82 ± 37.83) and 152.8 ± 72.33 days respectively (P = 0.560).
  
  
  CONCLUSIONS
  Besides the differences between groups regarding the baseline characteristics of patients, the results of this study suggest that in cases of tibial plafond fractures, the management with a hybrid external fixation as a definitive procedure might involve a faster union than a two-stage management with final plate fixation.
authors.affiliation: Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain; Department of Orthopaedics and Traumatology, Hospital General de Catalunya, Street Pedro i Pons 1, 08190, Sant Cugat del Vallés, Spain.
authors.forename: Luis Natera
authors.initials: LN
authors.lastname: Cisneros
authors.affiliation: Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Gómez
authors.affiliation: Department of Orthopaedics and Traumatology, Cima Clinic, Passeig Manuel Girona 29, 08034 Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Alvarez
authors.affiliation: Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain.
authors.forename: Angélica
authors.initials: A
authors.lastname: Millán
authors.affiliation: Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: De Caso
authors.affiliation: Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Soria
keywords: Fracture healing; Tibial fracture; fracture fixation; hybrid external fixation; orthopedic fixation devices; polyaxial locking plates; tibial plafond fractures