External Fixator vs. Locking Compression Plate in “Supracutaneous” Mode for Open Distal Tibial Fractures: A Comparison on Economics, Union, Functional Outcome and Complications

Abstract

Objectives Historically, in the pre-antiseptic era, there was a great fear of open tibial factors because of high incidence of infection eventually leading to amputation and in many cases septicemia and death. Despite improvements in surgical techniques in the last century, the optimum treatment for open type IIIa and Type II tibial farcture remains controversial. Literature available on use of Ex-fix as a definitive and permanent modality is very sparse and is not encouraging. In order to maintain biology of the fracture and to expedite the healing process many institutions and surgeons are using Locking compression plate as an external fixator which is fondly called as supracutaneous plating (SCP). Material and Methods The patients who had Gustilo and Anderson type II and IIIa # of distal Tibia were enrolled in this study. They were randomized into 2 groups. In one group (Ex-Fix) external fixator was applied in and in another group SCP was done. Four general indicators, including direct cost of hospitalization, first surgery time, time to full weight bearing, and time to complete union were compared between the groups. The functional outcome of the ankle was assessed. Presence of infection, Time to union was noted in both cases. Results Mean time to fracture union was statistically less in SCP group 5.84 months as compared to 7.21 months in Ex–fix group. Also, 12 patients in Ex-fix group had to undergo a reoperation as compare to only 1 in SCP group. This led to higher cost of expenditure and higher duration of stay in Ex-fix group. AOFAS Score, Teeny and Wiss were better in SCP group as compared to Ex-fix group. Conclusion Highlighting the role Of LCP in Supracutaneous mode as a definitive and final surgery , thus reducing the financial and psychological implication of reoperations in open grade and tibial fractures which are seen in patients managed with Ex-fix in definitive mode or as an interval for secondary nailing, we recommend the use of routine use of SCP in such tibial fractures after thorough debridement and diligent handling of soft tissue.