Does the Fibula Need to be Fixed in Complex Pilon Fractures?

Area of Science:

• Orthopedic surgery
• Trauma surgery

Background:

• Complex pilon fractures with metadiaphyseal dissociation are challenging injuries.
• Management decisions, including fibula fixation, impact outcomes.

Purpose of the Study:

• To evaluate the necessity of fibula fixation in complex pilon fractures.
• To compare outcomes of fixed versus non-fixed fibulas in these injuries.

Main Methods:

• Retrospective case-control study at a Level 1 Trauma center.
• Included skeletally mature patients with metadiaphyseal plafond fractures.
• Analyzed alignment, surgical procedures, and complications from radiographs and charts.

Main Results:

• No significant difference in final alignment between groups with or without fibula fixation.
• Fibular fixation was associated with a higher rate of plate removal (P < 0.0001).
• Fixation was sometimes used to aid reduction or augment fixation in poor bone stock.

Conclusions:

• Fibular fixation is not routinely necessary for pilon fracture reconstruction.
• It may be beneficial in specific cases for reduction or external fixation augmentation.
• Higher plate removal rates suggest potential complications associated with fibula fixation.