Summary
The studies summarized in this report do not provide conclusive evidence regarding
the superiority of internal or external fixation in the treatment of tibial pilon
fractures: clinical and functional outcomes are similar across both groups and the
difference in complication rates is ambiguous. There may be some indication that external
fixation gives rise to slower union times and a higher rate of malunions and nonunions
compared with internal fixation, however, more severely injured patients (patients
with high grade closed fractures and any grade open fractures) tended to receive external
fixation, which makes direct comparisons between the two groups difficult.
