Distal tibial fractures: comparison between external locked plate and conventional open reduction and internal fixation

Background Distal tibial fractures are notorious for being associated with skin complications such as wound dehiscence and infection. The use of angle-stable external locked plate has a dual advantage, acting as an external fixator, which avoids the complications associated with conventional open surgery, and avoiding the cumbersome bulky external frames traditionally used for lower limb fractures. Moreover, joint spanning is not necessary in this technique, leaving the ankle joint free, avoiding joint stiffness commonly associated with the conventional frames. Patients and methods A total of 56 patients with closed distal tibial fractures were randomly assigned in two equal groups. Group A comprised patients treated with the conventional open reduction and internal fixation, whereas group B comprised patients treated with external locked plate (supracutaneous plate). The patients were assessed according to the Klemn and Borner scoring system at the end of follow-up. Results Group B patients had significantly better clinical and radiological outcome than group A. The union in group B was more rapid (12.96±2.74 weeks) than in group A (18.68±12.12 weeks), with a statistically significant difference between them. The rate of complications was significantly less in the group B, with only three patients having superficial self-limiting infection in comparison with group A, with 11 patients having deep infection and skin dehiscence with exposure of the plate. None of the cases of group B developed implant failure, whereas seven cases in group A developed implant failure. Conclusion Treatment of closed distal tibial fractures by external locked plate could result in a better functional outcome than conventional open reduction and internal fixation, while avoiding the skin complications associated with the conventional plating. Level of evidence Level II: prospective randomized double-blinded study.