Hybrid External Fixation as A Comprehensive, Safe, and Effective Solution for Periarticular Tibial Fracture with Soft Tissue Compromise.

Abstract

Introduction: High-energy trauma to the knee and ankle resulting in complex periarticular fractures of the tibia is usually difficult to treat using conventional plating methods owing to the association of poor soft-tissue conditions. The hybrid external fixation combines the advantages of Ilizarov ring construct in the metaphyseal region and uniplanar external fixator at diaphyseal region, which can provide satisfactory stability and early mobilization, allows optimal conditions for soft-tissue healing.

Aim and objective: This study evaluates the efficacy of hybrid external fixation for managing periarticular fractures of the tibia occurring at the knee and ankle with soft-tissue compromise, in terms of functional and radiological outcome and its complications.

Materials and methods: This is a retrospective study conducted in our hospital on 36 patients from outpatient department and casualty who have satisfied the inclusion and exclusion criteria during the period between January 2021 and December 2022. Patient were studied for their radiological and functional outcome after primarily managing by hybrid external fixators.

Results: Results were analyzed using RASMUSSEN scoring for knee and AOFAS scoring for ankle which revealed excellent outcomes, in 84.4% of patients with proximal tibial fractures and 82.4% of patients with distal tibial fractures.

Conclusion: Hybrid external fixators are advantageous, providing stability for fracture union, early mobilization, soft-tissue preservation, preservation of vascularity of bone, reduced operative time and radiation exposure, and cost-effective in a low-resource setting. Hence, we suggest the use of hybrid external fixators as a primary and definitive fixation strategy for periarticular fractures of tibia with soft tissue compromise.