IntroductionPostoperative stiffness is a common complication after high-energy tibial plateau fractures. Investigation into reported surgical techniques for the prevention of postoperative stiffness is limited. The purpose of this study was to compare the rates of postoperative stiffness after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not.MethodsTwo hundred forty-four patients met the inclusion criteria between the two academic Level I trauma centers, representing the retrospective observational cohort. Patients were separated based on prepping of the external fixator into the surgical field during second-stage definitive open reduction and internal fixation. One hundred sixty-two patients were in the prepped group and 82 were in the non-prepped group. Post-operative stiffness was determined by the need to return to the operating room for subsequent procedures.ResultsAt the final follow-up (mean = 14.6 months), patients in the non-prepped group had an increased rate of stiffness post-operatively (18.3% non-prepped versus 6.8% prepped; p = 0.006). No other investigated variables were associated with increased post-operative stiffness, including the number of days spent in the fixator and operative time. The relative risk for post-operative stiffness associated with complete fixator removal was 2.54 (95% CI 1.26-4.41; p = 0.008 on binary logistic regression; absolute risk reduction 11.5%).ConclusionAt the final follow-up, maintenance of an intraoperative external fixator as a reduction aid was associated with a clinically significant decrease in post-operative stiffness after definitive management of high-energy tibial plateau fractures, when compared with complete removal prior to prepping.