Transarticular External Fixation Research Articles

Translated article] Subtalar dislocations: Analysis of a case series. Our urgent treatment algorithm

Introduction and objectivesSubtalar dislocations are a rare entity (<1%) in traumatic foot injuries. There is a loss of anatomical relationship between the talus, calcaneus and scaphoid. There are only small-published series. Material and methodsWe present a series of patients (N=13) with subtalar dislocations in which a descriptive analysis of the main epidemiological, clinical and radiological variables was carried out, from which an urgent treatment algorithm is proposed. Cases with fractures of the neck of the talus, body of the calcaneus, or isolated Chopart fracture-dislocations were excluded. ResultsThe median age was 48.5 years with a predominance of males (69.23%). Five patients suffered falls or sprained ankles and the other eight suffered high-energy mechanisms. The medial dislocations (nine) predominated over the lateral ones (four). In addition, four patients presented open dislocations, two of them type IIIC that required amputation. CT scans were requested in 76.93% of patients and 10 presented associated bone lesions of the foot. Open reduction surgery was performed in all open lesions and in one case in which closed reduction failed. Five patients required a delta-type external fixator. Subchondral articular sclerosis was observed in 77.77% of cases; although only one required subtalar arthrodesis. ConclusionsSubtalar dislocations are a traumatic emergency that require early reduction and subsequent immobilisation. Transarticular temporary external fixation is a good immobilisation option in open dislocations. They are serious lesions with a high probability of early osteoarthritis.

The use of transarticular external fixation by arthrodiastasis in complex open proximal humeral fractures at Hospital Militar Central Colombia: A case series

Objective To describe the clinical and surgical characteristics of external fixation technique to manage complex open proximal humerus fractures caused by high-energy firearm injuries at the Hospital Militar Central, Colombia. Methods A retrospective case series of patients with open complex proximal humerus fractures (Gustilo &amp; Anderson III A-B or Neer III and IV) caused by long range or fragmentation weapons treated with external fixation. The variables are demographic data, range of motion, consolidation measurements, and functional outcomes according to the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) functional scale. Results Seven male patients, with high-energy injuries causing open complex proximal humerus fractures (Gustilo &amp; Anderson III A-B or Neer III or IV) underwent surgical treatment with external fixation and arthrodiastasis. Median age was 21.0 (19–24) years, mean treatment duration was 5.6 (4–7) months, and all patients completed 15 months of follow-up. Mean postoperative active movement measurements were flexion: 80° (40°–120°), abduction 85.7° (40°–130°), external rotation: 24.7° (10°–45°), and internal rotation: 23.6° (10°–45°). Mean postoperative pain according to visual analog scale was 2.7 (1–4) and mean Quick DASH was 36.2 (15.9–58). Two patients presented postoperative complications, one case each of infection and osteitis. Conclusion Complex open proximal humeral fractures caused by high-energy trauma treated with transarticular external fixation via arthrodiastasis show promising short-term and mid-term results with low complication rates, low levels of postoperative pain, and moderate functional results. This external fixation technique seems to be a valid option for the treatment of polytraumatic patients with humeral injuries. Longer follow ups and larger sample sizes studies must be presented to better characterize the clinical and satisfaction outcomes.

Luxaciones periastragalinas: análisis de una serie de casos. Nuestro algoritmo de tratamiento urgente

Introduction and objectivesSubtalar dislocations are a rare entity (<1%) in traumatic foot injuries. There is a loss of anatomical relationship between the talus, calcaneus and scaphoid. There are only small-published series. Material and methodsWe present a series of patients (N=13) with subtalar dislocations in which a descriptive analysis of the main epidemiological, clinical and radiological variables was carried out, from which an urgent treatment algorithm is proposed. Cases with fractures of the neck of the talus, body of the calcaneus, or isolated Chopart fracture-dislocations were excluded. ResultsThe median age was 48.5 years with a predominance of males (69.23%). Five patients suffered falls or sprained ankles and the other eight suffered high-energy mechanisms. The medial dislocations (nine) predominated over the lateral ones (four). In addition, four patients presented open dislocations, two of them type IIIC that required amputation. CT scans were requested in 76.93% of patients and 10 presented associated bone lesions of the foot. Open reduction surgery was performed in all open lesions and in one case in which closed reduction failed. Five patients required a delta-type external fixator. Subchondral articular sclerosis was observed in 77.77% of cases; although only one required subtalar arthrodesis. ConclusionsSubtalar dislocations are a traumatic emergency that require early reduction and subsequent immobilization. Transarticular temporary external fixation is a good immobilization option in open dislocations. They are serious lesions with a high probability of early osteoarthritis.

A novel surgical treatment of type 3 congenital elbow luxation in a dog

Congenital luxation of the ulnar and radius is a rare orthopaedic condition in the dog. This case report describes a novel surgical treatment for congenital elbow luxation in a medium-breed dog. A 6-week-old Kelpie presented for left forelimb lameness and deformity. Radiographs and computed tomography (CT) confirmed the diagnosis of unilateral ulnar and radius luxation. The surgical repair involved open reduction followed by fixation with an extraarticular pin and a transarticular external fixator. The outcome of surgery was improved leg function and weight-bearing, however, reluxation of the radial head was diagnosed 7 weeks following surgery. This technique may offer an alternative surgical option to improve clinical signs, as well as insight into improving the management of this condition.

Treatment of Elbow Luxation and Radius Fracture with Cerclage Transarticular External Fixation and Paraosseous Clamp Cerclage in a Cat

Treatment of Elbow Luxation and Radius Fracture with Cerclage Transarticular External Fixation and Paraosseous Clamp Cerclage in a Cat

Arthroscopic Ankle Arthrodesis with Circular External Fixator: Case Report

Category: Ankle Arthritis; Arthroscopy; Trauma Introduction/Purpose: One of the options for the surgical treatment of tibial pilon fracture is the circular external fixator. Similar results are found in the literature, with good outcomes in relation to a low incidence of infection, osteomyelitis and soft tissue injuries compared to open reduction and internal fixation. Even so, evolution to a probable arthrodesis occurs in 3-27% of cases, showing that the prognosis for this type of fracture is dismal. Options for performing joint fusion include open arthrotomy with joint decortication and internal fixation (plates and/or screws), in addition to arthroscopic joint preparation, a method that has been gaining popularity since 1983, in its first description. Fusion through circular external fixation is an excellent option that has shown good results in the literature. Methods: Patient with left tibial pilon fracture. Uniplanar external fixation was performed in the emergency room, with subsequent conversion to transarticular circular external fixation. After 4 months of review, the patient has evidence of tibiotarsal arthrosis. It was decided to perform arthrodesis using the arthroscopic technique, performing joint compression with circular external fixation, already installed in the patient. Spinal anesthesia was performed on the patient and the Smarch tourniquet was used. First, access to the anteromedial portal, trocar and optic passage was obtained, and the intermediate dorsal cutaneous branch of the superficial peroneal nerve was identified laterally, and the anterolateral portal was constructed. Through these portals, a 4.5mm Shaver blade was used to perform curettage and joint debridement, in addition to curettes and osteotomes. In addition to arthroscopic control, fluoroscopic observation was also performed for adequate joint preparation.Finally, joint compression was performed with the device already installed. Results: The patient presented complete consolidation of the tibio-tarsal arthrodesis. At the moment (2 years and 10 months postoperatively) the patient does not use crutches/gait accessories, does not limit his daily activities due to foot problems, does not have difficulty going down and up stairs, has good ankle alignment, plantigrade foot, has no joint pain and can walk long distances. Conclusion: This work showed a technique rarely reported or cited in the orthopedic literature, not presenting any article as an original description. Supported by the description of the procedure by the robust final functional results of the patient in question, this report establishes the basis for the widespread method and new works to emerge to enrich the debate and study around arthroscopic ankle arthrodesis using the Ilizarov method.

Modified Wendelburg caudomedial approach for treatment of a distomedial humeral condylar fracture in a cat

AbstractA 6‐year‐old outdoor cat presenting with a progressive 5‐month duration right thoracic limb lameness was diagnosed with an articular fracture of the distal caudomedial part of the right humeral condyle. Surgical repair was performed via the modified Wendelburg caudomedial approach to the elbow using a positional screw to reduce the fragment and applying a temporary transarticular external skeletal fixator. Three weeks after surgery, the transarticular external fixator was removed and 6 weeks after surgery, a CT scan was performed revealing satisfactory bone healing. Eight months after the surgery, the cat had no lameness and a normal level of exercise.

Biomechanical Analysis of Stability of Palmar Lateral Joint Capsule Ligament Complex of a Track and Field Athlete

This study is to explore the influence of palmar lateral joint capsule ligament complex on dorsal stretching stability of wrist lateral joint and to analyze its biomechanical principle, so as to provide reference for clinical medicine. To study the biomechanical characteristics of palmar lateral joint capsule posterior ligament complex, in this study we selected 8 freshly donated body upper limbs including 5 left ones and 3 right ones as research objects. By cutting off forearms and hand soft tissues and leaving wrist lateral joint capsule ligaments, the complex model was made, which can be used as normal sample. Extending from styloid process of radius to styloid process of ulna, we operated on distal ulna and cut off palmar lateral joint capsule ligament complex along an arc line and regarded it as a damaged sample. Through simulating actual clinical operation, the sample was repaired using an external fixation and analyzed according to wrist joint displacement load values. Results showed that regarding the same sample, the comparison of different displacement points was of statistical significance. In all, palmar wrist lateral joint capsule ligament complex is of vital importance, which is a key structure that determines the stability of wrist joint. Once the complex is injured, it will cause extremely serious consequences in which the most significant one is the wrist joint instability. In clinical practice, it cannot achieve very satisfactory effect by only repairing palmar lateral joint capsule ligament complex. By only relying on a transarticular external fixator, the complex can be successfully repaired and thus the complex injury displacement can be avoided and wrist joint stability be secured.

Major Trauma and Severe Burn: A Synergistic Mortality. Case Report and Literature Review

Abstract Case Presentation A 42-year-old man was transferred to our institution after a high-energy accident (an explosion). He presented second-degree burns on 20% of the total body surface area (TBSA), affecting the lower hemiabdomen and the lower right limb. He also presented a supraintercondylar open fracture of the right femur (Gustilo I). The burns were treated with debridement and coverage with mesh graft, while the fracture required an early transitory transarticular external fixation with delayed definitive osteosynthesis. Our patient presented good local and systemic evolution. We can offer a eleven-month follow-up. Discussion The literature supports that the combination of trauma and burn injuries is a relatively rare pattern, which may explain the lack of knowledge and studies on this subject. This double injury has demonstrated a synergistic effect on mortality. The management of soft tissues in the coexistence of an open fracture and a burn in the same limb is a challenge. The method and timing of the treatment of the fracture directly impacts the treatment of the burn (and vice versa), and most authors tend to treat the fracture first. All of the studies reviewed emphasized the importance of the multidisciplinary approach. Conclusions We have presented a complex case combining major trauma and severe burns. Although there is a lack of studies in the literature on this subject, the papers state that this is an unusual pattern with a synergistic effect on mortality. In our experience, the management of soft tissues and the multidisciplinary approach play a central role, as it is also stated in the literature. The management of these patients is still controversial, and more studies are needed.

Vascularized pedicled graft from distal radius for scaphoid nonunion with double stabilization: A long term follow up study

PurposeThe aim of the present study is to present the long-term efficacy of the graft of the distal radius based on the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) for the treatment of scaphoid nonunion with a proposed treatment of double stabilization with Kirschner wires and external fixator. MethodsBetween 2007 and 2013 we retrospectively reviewed 11 patients who were operated for established scaphoid nonunion with pedicled vascularized distal radius graft based on the 1,2 ICSRA in our department. Stabilization of the graft was achieved with Kirschner wires and the wrist was immobilized with a transarticular external fixator. All patients were evaluated pre- and post-operatively both clinically and radiologically. The DASH score was also completed by the patients before and after the operation. The minimum follow-up of the patients was 5 years. ResultsThe mean age of the patients was 28.64 years (range, 18–49 years). Ten patients were males (90.91%) and one female (9.09%). In all patients, union was achieved. The mean time of union was 11.2 weeks (range, 8–18 weeks). The mean follow-up was 61.32 months (range, 60–72 months). Compared to the contralateral hand there was noticed 14° lack in flexion and 18° in extension. The mean DASH score showed also significant improvement from 23.1 (range, 9.4–50.6) preoperatively to 4.72 (range, 0–22.8) during the last follow-up. ConclusionThe 1,2 ICSRA distal radius graft consists a trustworthy pedicled vascularized graft for the treatment of nonunion presenting very promising long-term outcomes.

Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

BackgroundThe topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures.MethodsBetween January 2012 and December 2015, 43 patients were diagnosed as SER IV ankle fractures, 20 underwent ORIF and transarticular external fixation (TEF) without DLR (group 1), 23 were treated with ORIF and DLR (group 2). The pre- and post-operative radiographic examination were performed, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS), the Medical Outcomes Short Form 36-item questionnaire score (SF-36), and the ankle range of motion (ROM) were used for functional evaluation.ResultsIn both groups, the three scores improved significantly after surgery, but there was no significant difference between the two groups. At 6 weeks after surgery, patients in group 2 had better ankle ROM than group 1 (29.35 ± 2.033 vs. 40.35 ± 3.550, P < 0.001), but there was no difference at 12 months postoperatively. No cases of bone nonunion or post-traumatic arthritic changes were seen during the follow-up. Patients in group 1 required a shorter time to achieve fracture union than patients in group 2.ConclusionsORIF with TIF is an optional strategy to manage SER IV ankle fractures as it achieves comparable functional results to ORIF with DLR. It also allows patients to start relatively earlier weight-bearing and may promote fracture union.

Diagnosis and treatment of complications following trans-articular external fixation for elderly patients with distal radius fracture of type C3

Objective To investigate the causes and treatment strategy for postoperative complications following trans-articular external fixation in the elder patients with distal radius fracture of type C3. Methods The clinical data were retrospectively studied of the 226 patients with distal radius fracture of type C3 who had been treated by trans-articular external fixation from January 2011 to December 2016 at Department of Orthopaedics, Union Hospital. Of them, 42 (18.6%) suffered from postoperative complications. They were 12 men and 30 women, aged from 65 to 83 years (average, 68.4 years). Results Of the 42 patients, 22 (52.4%) had loss of reduction which was improved by timely adjustment of their external fixators, 14 (33.3%) had joint stiffness which was mitigated by physical therapy, 5 (11.9%) had traumatic arthritis which was relieved after medication and physical therapy, and one (2.4%) had pin tract infection which was controlled after antibiotic treatment and regular dressing change. Conclusion Although trans-articular external fixation is an effective treatment for elder patients with distal radius fracture of type C3, it is likely to result in a major complication, loss of reduction, which should be treated timely and effectively to avoid serious consequences. Key words: Radius; Fractures; External fixator; Complications of fracture

Management of Complete Talocrural Luxations by Selective Talocrural Arthrodesis using Hybrid Transarticular External Skeletal Fixation in Dogs.

This article presents a novel surgical technique in the management of open complete talocrural luxations and evaluates the results, and clinical benefits with its routine clinical utilization. Retrospective study. Seventeen medium- or large-breed client-owned dogs of different breed, age and sex with complete talocrural luxations and radiographic follow-up of at least 24 weeks duration. Selective talocrural arthrodesis was performed by using a hybrid transarticular external skeletal fixator frame. Clinical and radiographical evaluation was performed regarding the lesion, concomitant injury, duration of the surgery, time to first use of the limb, fixator removal time, complications and clinical outcomes. Dogs started to use the injured limb between postoperative days 1 to 11. Pin or wire tract related complications were observed in all dogs. Time to fixator removal ranged from 57 to 90 days with a median of 73 days. All of the operated joints with an exception of one dog resulted in talocrural fusion. Mid-term clinical outcomes score was regarded as excellent in 13/17 dogs, good in 3/17 dogs and poor in 1/17 dogs subject to authors' evaluation. A transarticular hybrid external fixator may allow early use of postoperative limb with an excellent patient compliance and is well tolerated as well. The technique showed a promising opportunity of providing favourable limb use.

Early and mid-term results of transarticular external fixation in the treatment of supination-external rotation type IV equivalent ankle fractures

PurposeTo investigate the early and mid-term results of open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no deltoid ligament repair (DLR) in the treatment of supination-external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B 3.1) and provide evidence for clinical practice. MethodsThis study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014. There were 13 males and 9 females, mean age 38.9 years (range, 17–73 years). Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents (11 cases), falling from height (6 cases) and sports injuries (5 cases). The mean period of hospitalization was 9.8 days (range, 6–14 days). For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8–10 weeks. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 56.86 ± 4.400, the Medical Outcomes Short Form 36-item (SF-36) questionnaire score was 57.41 ± 4.102 and the visual analog score (VAS) was 5.50 ± 1.058. Patients' main complaints about inconvenience of daily life were also recorded. ResultsAll the 22 patients were followed up for 24–63 months (mean, 33.6 months). None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 ± 5.096, 79.59 ± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data (t = 26.221, p < 0.001; t = 11.910, p < 0.001; t = 11.571, p < 0.001). The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients' main complaints were inconvenience of clothing (17 cases) and extremity cleaning (5 cases). ConclusionIn the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satisfactory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.

Comparison of external fixation with or without limited internal fixation for open knee fractures

Objective: To explore the characteristics and methods of different fixation methods and prevention of open knee joint fracture. Methods: The data of 86 cases of open knee joint fracture admitted from January 2002 to December 2015 in Department of Orthopaedics, Affiliated Hospital of Chengdu University were analyzed retrospectively.There were 65 males and 21 females aged of 38.6 years. There were 38 cases treated with trans articular external fixation alone, 48 cases were in the trans articular external fixation plus auxiliary limited internal fixation group. All the patients were treated according to the same three stages except for different fixation methods. Observation of external fixation and fracture fixation, fracture healing, wound healing and treatment, treatment and related factors of infection control and knee function recovery. χ(2) test was used to analyze data. Results: Eleven patients had primary wound healing, accounting for 12.8%. Seventy-five patients had two wounds healed, accounting for 87.2%. Only 38 cases of trans articular external fixator group had 31 cases of articular surface reduction, accounting for 81.6%; Five cases of trans articular external fixator assisted limited internal fixation group had 5 cases of poor reduction, accounting for 10.4%; There was significant difference between the two groups (χ(2)=44.132, P<0.05). Take a single cross joint external fixation group, a total of 23 cases of patients with infection, accounted for 60.5% of external fixation group; trans articular external fixation assisted limited internal fixation group there were 30 cases of patients with infection, accounting for the assistance of external fixator and limited internal fixation group 62.5%; There was significant difference between the two groups(χ(2)=0.035, P>0.05). Five cases of fracture nonunion cases of serious infection, patients voluntarily underwent amputation. The Lysholm Knee Scale: In the external fixation group, 23 cases were less than 50 points, accounting for 60.5%, 15 cases were more than 50 points, accounting for 39.5%, external fixation and limited internal fixation group 20 cases were less than 50 points, accounting for 41.7%, 28 cases were more than 50 points, accounting for 58.3%; There was significant difference between the two groups(χ(2)=1.279, P>0.05). Conclusions: Prevention and control of infection is a central link in the treatment of open fracture of the knee. Trans articular external fixator plus limited internal fixation is an important measure to treat open fracture of the knee-joint.

PRWE application in distal radius fracture: comparison and correlation with established outcomes

ObjectiveThe study aimed to evaluate the correlation between the PRWE score with other measurements that are already widely used. MethodsThis was a prospective, cross-sectional, single-center study. Sixty-eight consecutive patients underwent surgical treatment for distal radius fractures (internal fixation by locked volar plate or transarticular external fixation). They were evaluated independently by PRWE, DASH, VAS range of motion, strength, and radiographic criteria, in one year of follow up. The Mann–Whitney test was used to compare continuous variables and the Spearman correlation to correlate the outcomes of interest. ResultsPRWE correlated significantly with DASH (p<0.001) and VAS (p<0.001). There were no significant correlations with other outcome measures. ConclusionPRWE presents significant moderate correlation only with DASH and VAS. Range of motion, strength, and radiographic criteria do not interfere in the PRWE outcome.

Unstable fragility fractures of the ankle in the elderly: Transarticular Steinmann pin or external fixation

IntroductionBecause of poor skin conditions and comorbidity, open reduction and internal fixation in ankle fractures is frequently contra-indicated in the elderly. This study reports the results of two temporary fixation types in fragility fractures in the older patient: transarticular Steinmann pin fixation and external fixation. MethodsPatients aged over 60 treated with a Steinmann pin or external fixation were retrospectively included. Patient, fracture and treatment characteristics were collected. ResultsFifteen patients were included. Nine were managed using a Steinmann pin and six by external fixation. All reached fracture consolidation. Patients treated with a Steinmann pin underwent a median of 2 operations and the pin was left in situ for 80 days. Three patients suffered from superficial wound infection. X-ray showed malreduction in 67% and only two patients returned to pre-injury mobility.A median of 2 operations with 32 fixation days was reported in the external fixation group. This group showed one deep infection. In 50% there was malreduction, one patient experienced disability in ambulation at the end of treatment. ConclusionBoth techniques show few complications, but have, as expected, poor results in fracture reduction and functional outcome. External fixation and subsequent internal fixation could result in better functional outcome.

Aplicação do PRWE na fratura da extremidade distal do rádio: comparação e correlação com desfechos consagrados

ObjectiveThe study aimed to evaluate the correlation between the PRWE score with other measurements that are already widely used. MethodsThis was a prospective, cross‐sectional, single‐center study. Sixty‐eight consecutive patients underwent surgical treatment for distal radius fractures (internal fixation by locked volar plate or transarticular external fixation). They were evaluated independently by PRWE, DASH, VAS range of motion, strength, and radiographic criteria, in one year of follow up. The Mann‐Whitney test was used to compare continuous variables and the Spearman correlation to correlate the outcomes of interest. ResultsPRWE correlated significantly with DASH (p<0.001) and VAS (p<0.001). There were no significant correlations with other outcome measures. ConclusionPRWE presents significant moderate correlation only with DASH and VAS. Range of motion, strength, and radiographic criteria do not interfere in the PRWE outcome.

Management of a complete stifle luxation with a hinged transarticular hybrid external fixator in a dog

A 2 years old, 15 kg, male, mix breed dog that was presented with a right open tibial fracture and left complete stifle luxation. Cranial and caudal cruciate ligaments with medial and lateral collateral ligaments were completely torn. Stabilization of the stifle was established with a hinged transarticular external fixator. After fixator removal, radiographic findings were normal besides some periarticular osteophyte formations. Physical therapy was initiated postoperatively. Now the dog can perform all daily activities with mild lameness

Staged treatment of complex tibial plateau fractures with temporary transarticular external fixation and delayed plate fixation

Objective To evaluate the clinical efficacy of staged treatment of complex tibial plateau fractures with temporary transarticular external fixation and delayed plate fixation. Methods Enrolled in this study were 44 cases of complex tibial plateau fracture who had been treated from January 2011 to January 2014. Temporary transarticular external fixation and delayed plate fixation was adopted in 22 patients (observation group) , involving 14 men and 8 women with an average age of 45.5±11.4 years, and 10 left sides and 12 right sides. By the Schatzker classification, 13 cases were type Ⅴ and 9 type Ⅵ. Calcaneal traction and plate fixation was adopted in the other 22 patients (control group) , involving 13 men and 9 women with an average age of 43.8±10.4 years, and 8 left sides and 14 right sides. By the Schatzker classification, 12 cases were type Ⅴ and 10 type Ⅵ. The 2 groups were evaluated by the time from hospitalization to plate fixation, operation time, intra-operative bleeding volume, hospitalization time, healing time, complications and Hospital for Special Surgery (HSS) scoring at the final follow-ups. The 2 groups were compatible with no significant differences regarding the preoperative general data (P>0.05). Results The 44 patients were followed up for 12 to 30 months (mean, 18.6 months). There were significant differences between the 2 groups in the time from hospitalization to plate fixation, operation time, intra-operative bleeding volume and hospitalization time (P 0.05). Conclusions Although both methods can treat complex tibial plateau fractures, temporary transarticular external fixation and delayed plate fixation may be preferable because it can lead to decreased hospitalization time, less intra-operative bleeding volume, fewer surgical complications and good functional recovery of the knee. Key words: External fixation; Tibial fracture; Fracture fixation, internal; Knee joint