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Foot & Ankle International 38(6)

Figure 1. Varus mechanism of failure and medial plating location.

however, 4 of 5 patients (80%) with laterally placed plates
had mechanical complications (P = .006).
For the comminuted fracture group (valgus) (n = 63), 33
were plated medially (52.4%) and 30 were plated laterally
(47.6%). Overall, mechanical complications were seen in
17 patients (27%). Twelve of 33 patients (36.4%) had
medial plates, and 5 of 30 patients (16.7%) with mechanical
complications were plated laterally (Figure 2) (P = .156).
Post hoc analysis showed the comminuted fracture group to
be underpowered, however. For a given effect size, a sample size of more than 90 patients each in the medial and
lateral plate group would be required to reach a power of
0.80. Description of similar analysis of patients with >1
year of follow-up only (group A) can be found in Table 2.
Mechanical complications for all evaluated patients in
the study were noted in 26 of 103 patients (22 from Group
A and 4 from Group B) for a total of 25.2%. There was no
correlation between mechanical complications and AO/
OTA classification type (Table 3). Of 26 patients, 21 sustained AO/OTA type 43-C1 through C3 fracture pattern,
whereas 5 were AO/OTA type A1-A3. Mechanical complications did not correlate with open injury, as 13 patients
(50%) sustained open wounds whereas the other 50% had a
closed injury.
Wound complications associated with our patient population were analyzed. Looking at groups A and B together,
in the transverse fracture group (n = 40) there were 9 wound
complications for an overall rate of 22.5%. Of those, 8 were

plated medially (8/35 = 22.9%) and 1 was plated laterally
(1/5 = 20%) (P = 1.0). For the comminuted fracture group
(n = 63), there were 17 wound complications (27%). Of
those, 11 were plated medially (11/33 = 33.3%) and 6 were
plated laterally (6/30 = 20%) (P = .581).
Finally, no other patient characteristics demonstrated
statistical significance with the exception of time to weight
bearing as tolerated (WBAT) as determined by each treating
surgeon at the time of clinical follow-up. For patients with
a transverse fracture that was plated medially, the mean
time to WBAT was 12.4 weeks as compared to those whose
fracture was plated laterally, with time to WBAT being 14.4
weeks (P = .221). The comminuted fracture group with
medial plate were allowed WBAT at 13.7 weeks, on average, compared with those with lateral plates at 11.7 weeks
(P = .013).

Discussion
Tibial pilon fractures are frequently accompanied by a rotational component in addition to axial load, which should be
resisted with a chosen fixation method. Rotational forces not
only affect the distal tibia but often result in a fibular fracture
as well, allowing for a marker during radiographic evaluation. As previously described, comminuted fibular fractures
are seen as a result of valgus stresses, whereas transverse
fractures of the fibula result from varus angulation.1,19
Furthermore, several authors showed that associated fibular
Table of Contents for the Digital Edition of Foot & Ankle International - June 2017
