{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T05:56:40Z","timestamp":1763359000383,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Pilon fractures are associated with high-energy injuries, and there is presently much debate as to optimal fixation strategies and timing of intervention. There is little evidence comparing the type of fibular fixation during pilon fracture fixation. The purpose of this study was to compare fibular fixation methods in complex pilon injuries as it relates to pilon union rates and development of post-traumatic arthritis. Methods: This was a retrospective review from an urban Level 1 trauma center from January 2009 to May 2019, including patients age \u2265 18 who sustained a pilon fracture with an associated fibula fracture. Patients were allocated into one of three groups based on fibular fracture treated with plating, intramedullary device, or no fixation. Radiographic analysis was performed postoperatively and at final follow up to evaluate for tibial or fibular nonunion, malunion, talocrural angle, and ankle Kellgren\u2013Lawrence grade. Results: Of the 107 patients in this study, 42 underwent surgical fixation of their fibular fracture. There were no differences with respect to tibial or fibular union rates amongst the three groups. Furthermore, there were no differences in the presence of radiographic ankle arthritis at final follow up. However, Kellgren\u2013Lawrence arthritis grading did appear to be a more severe grade in patients who did not undergo fibular fixation (p = 0.001). Conclusions: Fibular intramedullary fixation does not appear to influence tibial or fibular nonunion rates as compared to plating in complex pilon injuries.<\/jats:p>","DOI":"10.3390\/jcm14020358","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T05:17:08Z","timestamp":1736399828000},"page":"358","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Impact of Fibular Fixation Method on Pilon Fracture Healing"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2032-8786","authenticated-orcid":false,"given":"Anthony","family":"Perugini","sequence":"first","affiliation":[{"name":"OhioHealth, Department of Orthopedics, Columbus, OH 43228, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Hyland","sequence":"additional","affiliation":[{"name":"OhioHealth, Department of Orthopedics, Columbus, OH 43228, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5712-5539","authenticated-orcid":false,"given":"James","family":"Iandoli","sequence":"additional","affiliation":[{"name":"OhioHealth, Department of Orthopedics, Columbus, OH 43228, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Hill","sequence":"additional","affiliation":[{"name":"OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Grant Medical Center, Columbus, OH 43215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Peabody","sequence":"additional","affiliation":[{"name":"OhioHealth, Department of Orthopedics, Columbus, OH 43228, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4731-1917","authenticated-orcid":false,"given":"Daniel","family":"DeGenova","sequence":"additional","affiliation":[{"name":"OhioHealth, Department of Orthopedics, Columbus, OH 43228, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallory","family":"Faherty","sequence":"additional","affiliation":[{"name":"OhioHealth Research Institute, Riverside Methodist Hospital, Columbus, OH 43214, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Taylor","sequence":"additional","affiliation":[{"name":"OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Grant Medical Center, Columbus, OH 43215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"ref_1","first-page":"432","article-title":"Tibial pilon fractures: A review of incidence, diagnosis, treatment, and complications","volume":"77","author":"Mauffrey","year":"2011","journal-title":"Acta Orthop. Belg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/S0030-5898(03)00082-8","article-title":"Pilon Fractures: Assessment and Treatment","volume":"33","author":"Borrelli","year":"2002","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_3","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","year":"1973","journal-title":"Injury"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/00005131-199902000-00002","article-title":"A Staged Protocol for Soft Tissue Management in the Treatment of Complex Pilon Fractures","volume":"13","author":"Sirkin","year":"1999","journal-title":"J. Orthop. Trauma"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.2106\/00004623-200310000-00005","article-title":"Outcomes After Treatment of High-Energy Tibial Plafond Fractures","volume":"85","author":"Pollak","year":"2003","journal-title":"J. Bone Jt. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1177\/107110070602700406","article-title":"Results and Outcomes After Operative Treatment of High-Energy Tibial Plafond Fractures","volume":"27","author":"Harris","year":"2006","journal-title":"Foot Ankle Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/00005131-199902000-00003","article-title":"Two-Staged Delayed Open Reduction and Internal Fixation of Severe Pilon Fractures","volume":"13","author":"Patterson","year":"1999","journal-title":"J. Orthop. Trauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/BOT.0000000000000304","article-title":"Does the Fibula Need to be Fixed in Complex Pilon Fractures?","volume":"29","author":"Kurylo","year":"2015","journal-title":"J. Orthop. Trauma"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2438","DOI":"10.1016\/j.injury.2015.09.035","article-title":"Necessity for fibular fixation associated with distal tibia fractures","volume":"46","author":"Taylor","year":"2015","journal-title":"Injury"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1097\/BOT.0000000000000695","article-title":"Fibular Fixation in Distal Tibia Fractures: Reduction Aid or Nonunion Generator?","volume":"30","author":"Torino","year":"2016","journal-title":"J. Orthop. Trauma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/BOT.0b013e3181eb5c4f","article-title":"Intramedullary Fixation of Fibular Fractures Associated with Pilon Fractures","volume":"24","author":"Evans","year":"2010","journal-title":"J. Orthop. Trauma"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e114","DOI":"10.1097\/BOT.0b013e3182694a2d","article-title":"Intramedullary Nail Fixation of Fibular Fractures Associated with Tibial Shaft and Pilon Fractures","volume":"27","author":"Stewart","year":"2013","journal-title":"J. Orthop. Trauma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jcot.2020.12.025","article-title":"Complications after fibula intramedullary nail fixation of pilon versus ankle fractures","volume":"16","author":"Faber","year":"2021","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1177\/107110079401501105","article-title":"Intramedullary Screw Fixation of Lateral Malleolus Fractures","volume":"15","author":"Bankston","year":"1994","journal-title":"Foot Ankle Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1177\/10711007231221991","article-title":"Image Rotation Alters Apparent Fibula Length: An Evaluation of Talocrural Angle, Shenton Line, and Dime Sign","volume":"45","author":"Jackson","year":"2024","journal-title":"Foot Ankle Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.joca.2014.11.010","article-title":"Radiographic evaluation of posttraumatic osteoarthritis of the ankle: The Kellgren-Lawrence scale is reliable and correlates with clinical symptoms","volume":"23","author":"Holzer","year":"2015","journal-title":"Osteoarthr. Cartil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e043","DOI":"10.1097\/OI9.0000000000000043","article-title":"Long-term outcomes after operative treatment for tibial pilon fractures","volume":"2","author":"Ochen","year":"2019","journal-title":"OTA Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/S0020-1383(69)80066-5","article-title":"Fractures of the lower end of the tibia into the ankle-joint","volume":"1","year":"1969","journal-title":"Injury"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s00264-008-0654-4","article-title":"Stabilisation of the fractured fibula plays an important role in the treatment of pilon fractures: A retrospective comparison of fibular fixation methods","volume":"33","author":"Lee","year":"2009","journal-title":"Int. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/00003086-199708000-00016","article-title":"Results of surgical treatment of tibial plafond fractures","volume":"341","author":"Babis","year":"1997","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/00005131-199801000-00003","article-title":"External Fixation of Tibial Plafond Fractures: Is Routine Plating of the Fibula Necessary?","volume":"12","author":"Williams","year":"1998","journal-title":"J. Orthop. Trauma"},{"key":"ref_22","first-page":"2473011421S2473001002","article-title":"What are the Major Risk Factors for Nonunion in Pilon Fractures?","volume":"7","author":"Wilson","year":"2022","journal-title":"Foot Ankle Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.fcl.2015.09.003","article-title":"Corrective Osteotomies for Malunited Malleolar Fractures","volume":"21","author":"Weber","year":"2016","journal-title":"Foot Ankle Clin."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1007\/s12178-018-9519-7","article-title":"Evolution in Management of Tibial Pilon Fractures","volume":"11","author":"Bear","year":"2018","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"356","DOI":"10.2106\/00004623-197658030-00010","article-title":"Changes in tibiotalar area of contact caused by lateral talar shift","volume":"58","author":"Ramsey","year":"1976","journal-title":"J. Bone Jt. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2473011423S2473000150","DOI":"10.1177\/2473011423S00150","article-title":"Effect of Fibula Shortening on Medial Clear Space and Lateral Translation of the Talus: An Anatomical Cadaveric Study","volume":"8","author":"Mason","year":"2023","journal-title":"Foot Ankle Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.2106\/00004623-199712000-00006","article-title":"The Effect of Fibular Malreduction on Contact Pressures in an Ankle Fracture Malunion Model","volume":"79","author":"Thordarson","year":"1997","journal-title":"J. Bone Jt. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"85","DOI":"10.5704\/MOJ.2103.013","article-title":"Predictors of Functional Outcome in Unstable Ankle Fractures Treated Surgically\u2014A Prospective Cohort Study","volume":"15","author":"Balaji","year":"2021","journal-title":"Malays. Orthop. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/BOT.0b013e31818915d9","article-title":"Posttraumatic Ankle Osteoarthritis After Ankle-Related Fractures","volume":"23","author":"Horisberger","year":"2009","journal-title":"J. Orthop. Trauma"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/BOT.0b013e318172c811","article-title":"A Prospective Study Evaluating Incision Placement and Wound Healing for Tibial Plafond Fractures","volume":"22","author":"Howard","year":"2008","journal-title":"J. Orthop. Trauma"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"24730114241256552","DOI":"10.1177\/24730114241256552","article-title":"A Prospective Evaluation for a Possible Safe Skin Bridge in Elective Foot Surgery","volume":"9","author":"Moore","year":"2024","journal-title":"Foot Ankle Orthop."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/BOT.0000000000002637","article-title":"Reducing Complications in Pilon Fracture Surgery: Surgical Time Matters","volume":"37","author":"Shafiq","year":"2023","journal-title":"J. Orthop. Trauma"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/358\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:25:19Z","timestamp":1759919119000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,9]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020358"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020358","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,1,9]]}}}