Medial Plating in Open Pilon Fractures May Be Indicated in the Right Patient

A 55-year-old retired overweight male contractor with controlled type 2 diabetes is performing repairs on his barn when he slips and falls from a ladder. He catches his foot in the rungs and sustains a type 2 open pilon fracture with metaphyseal comminution (OTA/AO 43-C family) and an associated fibula fracture. The 6-cm open wound is located medially and is contaminated with clothing but not the surrounding environment. One of your partners performs a thorough surgical debridement, is able to close the wound, and applies a spanning ankle external fixator and asks you to care for the patient to provide a definitive operation. Please argue for and against inclusion of a medially based plate in the fixation construct through the open wound at the time of definitive fixation.