Optimal Management of High-Energy Pilon Fractures

The ideal treatment method for fibular fractures associated with high-energy pilon injuries remains unknown. In this investigation, the authors reviewed a consecutive series of 137 patients who sustained high-energy pilon injuries and assessed the effect of fibular fixation and timing on radiographic and clinical outcomes. At a mean follow-up of 18.7 months, the authors found that the presence or lack of fibular fixation did not have an effect on the timing or rate of union of the pilon fractures; similarly, there was no significant difference between these groups regarding the presence or development of coronal or sagittal malalignment intraoperatively or at final follow-up. Fibular union rates were also not significantly different between groups, but fibular fixation increased operative time in a statistically significant manner. Interestingly, when comparing fibular fixation during the temporization stage vs the definitive fixation stage, the authors found that early fixation of the fibular fracture also had no effect on alignment, healing, or complication rates. Fixation of the fibula during external fixation placement statistically increased operative time during temporization but did not significantly decrease operative time during definitive stabilization. The authors cannot recommend fibular fixation with all associated pilon fractures because the presence or timing of fibular fixation does not significantly change the radiographic outcomes, complication rate, or need for future surgical interventions. Future clinical analysis is needed to further delineate the indication for fibular fixation in this scenario.