Comparison of External and Internal Fixation for Management of Bicondylar Tibial Plateau Fractures in Terms of Surgical Site Infection

  • Muhammad Javaid Iqbal Professor & Head of Orthopedics, FMU / DHQ Hospital, Faisalabad Pakistan
  • Afzal Javid Senior Registrar, Orthopedics, DHQ Hospital, Faisalabad Pakistan
  • Shahzad Mahmood Shahid Senior Registrar, Orthopedics, DHQ Hospital, Faisalabad Pakistan
  • Fida Hussain Medical Officer, Orthopedics Govt. General Hospital, Samanabad Faisalabad Pakistan
  • Allah Rakha Senior Registrar, Orthopedics, DHQ Hospital, Faisalabad Pakistan
Keywords: Tibial plateau fractures, Bicondylar (type V & VI), External fixation, Internal fixation, Surgical site infection


Objective: To compare external and internal fixation for the management of bicondylar tibial plateau fractures in terms of surgical site infection (SSI). Study Design: Randomized Controlled Trial. Settings: Faisalabad Medical University and affiliated Hospitals, Faisalabad, Pakistan. Duration: May 15, 2017 to November 15, 2017. Methodology: Approval from the institutional ethical committee was taken. All the patients with diagnosis of Bicondylar (Schatzker types V and VI) tibial plateau fractures in acute trauma setting who fulfilled the selection criteria were entered in the study by taking informed written consent. All selected cases were guided/informed regarding risk and benefits of the procedure. Randomization was based on computer generated numbers and allotted A & B groups. Group A patients underwent open reduction and internal fixation and in Group B patients’ external fixation with illizarove ring fixator was applied. All the relevant information was filled on predesigned Performa. Post-operative superficial surgical site infection was noted at 4 weeks after surgery in the ward of each patient. According to the Centre of Disease Control and prevention (CDC) and Healthcare Infection Control Practices Advisory Committee (HICPAC) criteria for defining a superficial surgical site infection, the record from each patient was collected after carefully examining the surgical wound at 4 weeks after surgery. Results: Post-operative superficial surgical site infection was 10 %(n=4) in cases of Group-A and 47.5%(n=19) in cases of Group-B, whereas 90%(n=36) in Group-A and 52.5%(n=21) in Group-B had no SSI. Conclusion: We found lower rate of infection in cases treated with internal fixation than those undergoing external fixation for bicondylar tibial plateau fractures.