J Korean Fract Soc.  2020 Jul;33(3):125-133. 10.12671/jkfs.2020.33.3.125.

Comparison of a Novel Box-Frame External Fixator and Conventional Delta-Frame External Fixator in the Staged Treatment of Distal Tibia Fractures

  • 1Orthopaedic Trauma Division, Trauma Center, Gachon University College of Medicine, Korea
  • 2Department of Orthopedic Surgery, Gachon University College of Medicine, Incheon, Korea
  • 3Department of Orthopedic Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
  • 4Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea


Distal tibia fractures with severe soft-tissue edema or intra-articular fractures are treated by staged operations using external fixators. Definitive surgery that maintains ligamentotaxis has been difficult using existing fixators. This study introduced a novel ‘box-frame’ external fixator and evaluated its clinical usefulness.
Materials and Methods
This study included 45 patients (32 males, 13 females) diagnosed with distal tibia fractures who underwent staged operations between March 2012 and March 2016, with a follow-up of at least one year. The patients were divided into two groups. In one group, fixation was performed with a box-frame external fixator (Group A). In the other group, fixation was performed with a delta-frame external fixator (Group B). The following outcomes were evaluated: the time until definitive surgery, operative time of the definitive surgery, radiation exposure time, bone union, time to achieve bone union, postsurgical complications, American Orthopaedic Foot & Ankle Society anklehindfoot score, and ankle range of motion.
Compared to the delta-frame, the box-frame showed a statistically significant reduction in the mean radiation-exposure time and operative time during the definitive surgery by 58 seconds and 25 minutes, respectively. The differences in the time until definitive surgery, bone union, time to achieve bone union, postsurgical complications, and functional scores were not significant.
The box-frame external fixator can be a useful treatment method in the staged surgery of distal tibia fractures.


Distal tibia fracture; Staged operation; External fixator; Box-frame
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