Does external fixation result in superior ankle function than open reduction internal fixation in the management of adult distal tibial plafond fractures?

• The superior management technique for distal tibial plafond fractures remains contentious.
• All papers reviewed had multiple limitations therefore, neither can yet be widely advocated as superior.
• The treatment method chosen remains primarily on surgeon preference and experience.
• Further, high-quality research, is required before a firm conclusion can be reached as to the superior treatment technique.

BackgroundTraditionally distal tibial plafond fractures were managed with open reduction internal fixation however, high complication rates have prompted the use of external fixation as an alternative. No definitive review has been conducted and the issue of superior treatment method remains contentious. This review assesses the comparative effectiveness of both with regards ankle function.MethodA search strategy was formulated with keywords ensuring full use of Medical Subject Headings terms for maximum sensitivity with Boolean combinations. Multiple databases were used.ResultsAll papers had limitations, hence results and conclusions must be considered conservatively. Paper-1 demonstrated an association between ORIF and superior ankle function (P < 0.05). Papers-2 and -3 demonstrated no significant difference (P > 0.05) between treatment techniques.ConclusionsNeither method can yet be widely advocated as superior with the treatment method chosen remaining primarily on surgeon preference and experience. This review highlights the requirement for further, high-quality research in this area.