title: Does the Fibula Need to be Fixed in Complex Pilon Fractures?
abstract: OBJECTIVE
  To review a series of patients with complex plafond injuries with a metadiaphyseal dissociation who did not have the fibula fixed and compare with patients who had their fibula fixed using patients without a fibula fracture as a control group.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Level 1 Trauma center at a university hospital.
  
  
  METHODS
  Skeletally mature patients with a complete metadiaphyseal plafond fracture, and adequate presentation, postreduction, and healed radiographs to measure varus and valgus alignment.
  
  
  METHODS
  Surgical treatment [external fixator or open reduction internal fixation (ORIF)] of high energy pilon fractures.
  
  
  METHODS
  Metaphyseal alignment at the time of presentation, after fixation, and at union, surgical procedures performed, and complications.
  
  
  METHODS
  From 364 patients with plafond fractures, 111 had high energy injuries with metadiaphyseal dissociation and form the basis of the study. Radiographs and charts were reviewed for fracture characteristics, metaphyseal alignment at the time of presentation, after fixation, and at union, surgical procedures performed, and complications.
  
  
  RESULTS
  Of the 111 study patients, 93 patients were treated definitively with ORIF of the tibia and 18 patients were treated definitively in an external fixator. Within the 93 patients treated definitively with ORIF of the tibia, we identified 3 groups of patients those with a fibula fracture that was fixed (26 patients), those with a fibula fracture that was not fixed (37 patients), and those without a fibula fracture acting as the control group (30 patients). Between the 2 groups having a fibula fracture treated with ORIF of the tibia, there was no difference in fibula fracture pattern or location. For the 26 patients who had fibular fixation, it was performed in 11 patients at an average of 17 days for inability to hold length and alignment and in 15 patients to augment fixation in poor bone stock or to aid in the reduction. Patients with initial valgus deformity were more likely to have their fibula fixed. There was no difference in the postoperative or final alignment between the patients with fibula fractures (with or without fixation) and those without fibula fractures (P = 0.92). When comparing the 3 groups, the only statistical finding between the 2 groups was that those with fibula fixation required plate removal (P < 0.0001).
  
  
  CONCLUSIONS
  Fibular fixation is not a necessary step in the reconstruction of pilon fractures, although it may be helpful in specific cases to aid in tibial plafond reduction or augment external fixation. We found a higher rate of plate removal if the fibula was fixed.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors: *Sports Medicine North Orthopedics, Peabody, MA; †Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA; and ‡Department of Surgery, Boston University Medical Center, Boston, MA.
authors: John C
authors: JC
authors: Kurylo
authors: Neil
authors: N
authors: Datta
authors: Kendra N
authors: KN
authors: Iskander
authors: Paul
authors: P
authors: Tornetta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000601:surgery*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D005260:Female; D005360:Fibula / Q000293:injuries* / Q000601:surgery*; D017102:Fracture Healing; D000069076:Fractures, Multiple / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D020127:Recovery of Function; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult