{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T08:56:55Z","timestamp":1789721815510,"version":"4.0.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,6]]},"abstract":"\n Objective:<\/jats:title>\n To determine the outcomes after acute versus staged fixation of complete articular tibial plafond fractures.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Single Level 1 Trauma center.<\/jats:p>\n <\/jats:sec>\n \n Participants:<\/jats:title>\n 98 skeletally mature patients with OTA\/AO 43C type fractures who underwent definitive fixation with plate and screw constructs and had a minimum 6 months of follow-up.<\/jats:p>\n <\/jats:sec>\n \n Intervention:<\/jats:title>\n Acute open reduction internal fixation (aORIF) versus staged (sORIF) definitive fixation.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measurement:<\/jats:title>\n Rates of wound dehiscence\/necrosis and deep infection.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Acute (N = 40) versus staged (N = 58) ORIF groups had comparable rates of vascular disease, renal disease, and substance\/nicotine use, but aORIF patients had higher rates of diabetes mellitus (10% vs. 0%,\n P<\/jats:italic>\n < 0.001), which correlated with higher American Society of Anaesthesiologist scores (>American Society of Anaesthesiologist 3: 37.5% vs. 13.8%,\n P<\/jats:italic>\n = 0.02). Both groups achieved anatomic\/good reductions, as determined by postoperative CT scans, at rates greater than 90%; however, the sORIF group required modestly longer operative times to achieve this outcome (aORIF vs. sORIF: 121 vs. 146 minutes,\n P<\/jats:italic>\n = 0.02). Postoperatively, both groups had similar rates of wound dehiscence (2.5% vs. 6.9%,\n P<\/jats:italic>\n = 0.65), superficial infections (10% vs. 17.2%,\n P<\/jats:italic>\n = 0.39), and deep infections (10% vs. 8.6%,\n P<\/jats:italic>\n = 0.99). While the injury pattern itself required free flap coverage in 1 patient in each group, unplanned free flap coverage occurred in 10.0% and 10.3% of aORIF and sORIF groups, respectively. Overall, rates of unplanned reoperations, excluding ankle arthrodesis, did not differ between groups (aORIF vs. sORIF:12.5% vs. 25.9%,\n P<\/jats:italic>\n = 0.13).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n In select patients managed by fellowship-trained orthopaedic traumatologists, acute definitive pilon fixation can produce acceptable outcomes.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000002572","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T09:50:55Z","timestamp":1675331455000},"page":"294-298","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Outcomes After Acute Versus Staged Fixation of Complete Articular Tibial Plafond Fractures"],"prefix":"10.1097","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7978-4332","authenticated-orcid":false,"given":"Christopher D.","family":"Flanagan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reuben C.","family":"Lufrano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lazaro","family":"Mesa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Watson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjan R.","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.","family":"Maxson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Infante","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Donohue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katheryne","family":"Downes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy W.","family":"Sanders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan R.","family":"Mir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250614","doi-asserted-by":"crossref","first-page":"e250","DOI":"10.1097\/BOT.0000000000002312","article-title":"Long term trajectory of recovery following pilon fracture fixation","volume":"36","author":"Middleton","year":"2021","journal-title":"J Orthop Trauma"},{"key":"R2-20250614","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/S0020-1383(73)80089-0","article-title":"Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation","volume":"5","author":"R\u00fcedi","year":"1973","journal-title":"Injury"},{"key":"R3-20250614","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/00003086-199307000-00013","article-title":"Open reduction and internal fixation of tibial plafond fractures. 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