Vol. 11, Issue 1 (2025)

Background: Peri-articular knee fractures of the proximal tibia are known as tibial plateau fractures. The presentation is typically determined by the mechanism of injury, which is either low-energy trauma or very high-energy trauma. This investigation was designed to evaluate the effectiveness of acute spanning external fixation versus splintage in the early management of closed high-grade tibial plateau fractures prior to delayed definitive osteosynthesis in terms of soft tissue healing, time for surgery, quality of reduction, and cost on the health system.
Methods: This prospective randomized investigation was conducted on 40 patients who had closed high grade tibial plateau fractures. In one of the two equal groups, 20 patients were enrolled: A Group (Splintage above the knee): included patients who underwent temporary above knee splintage in flexion 15 to 20 degrees and admitted in a above knee splintage till definitve fixation.
Group B (N=20) (Spanning external fixator): included 20 patients who were prepared for a knee spanning external fixator on admission as first stage management till delayed definitive fixation.
Results: Spanning external fixator group had significantly shorter interval between applying the external fixator or the splintage till undergoing to internal fixation, operative time and total hospital stay compared to splintage above knee group (P<0.05). In comparison to the Splintage above knee group, the Rasmussen radiological score in the Spanning external fixator group was significantly higher (P=0.041). 
Conclusions: Spanning external fixator exhibited higher efficacy compared to splintage above knee in high grade tibial plateau fractures with shorter time of soft tissue healing, shorter operative internal fixation time indicating easier operation, shorter hospital stay, and better quality of reduction.