The Impact of Fibular Fixation Method on Pilon Fracture Healing

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Radiology

Background:

• Pilon fractures result from high-energy trauma, with ongoing debate regarding optimal fixation and intervention timing.
• Limited evidence exists comparing fibular fixation techniques in pilon fracture treatment.
• This study addresses the comparison of fibular fixation methods in complex pilon injuries.

Purpose of the Study:

• To compare fibular fixation methods (plating, intramedullary device, no fixation) in complex pilon fractures.
• To evaluate the impact of fibular fixation on pilon union rates.
• To assess the effect of fibular fixation on post-traumatic arthritis development.

Main Methods:

• Retrospective review of 107 patients (≥18 years) with pilon and associated fibula fractures from 2009-2019.
• Patients categorized into three groups: fibular plating, intramedullary fixation, or no fibular fixation.
• Radiographic analysis included union rates, malunion, talocrural angle, and Kellgren-Lawrence arthritis grading.

Main Results:

• 42 patients had surgical fixation of their fibula.
• No significant differences in tibial or fibular union rates were observed among the three groups.
• No significant differences in radiographic ankle arthritis were found, but severe arthritis was more common in the no-fixation group (p=0.001).

Conclusions:

• Fibular intramedullary fixation does not appear to affect tibial or fibular nonunion rates compared to plating in complex pilon injuries.
• While union rates are similar, avoiding fibular fixation may correlate with increased post-traumatic arthritis severity.