Fibula fixation is not associated with a higher rate of wound complications during pilon fracture open reduction internal fixation.

Abstract

There is a lack of consensus regarding indications for fibula fixation in pilon fractures. Reduction of the fibula fracture can assist with restoring lateral column length and reduction of the tibial plafond during pilon ORIF. However, there are theoretical concerns with wound complications and soft tissue insult. The purpose of this study is to compare short-term outcome measures after tibial plafond ORIF with and without supplemental fibula fixation using a validated national database. The American College of Surgeons' NSQIP database was utilized to identify all patients undergoing tibial plafond ORIF with and without fibula fixation between January 1, 2015 and December 31, 2020 using Current Procedural Terminology (CPT) codes 27827 and 27828, respectively. Open fractures and cases with concurrent open procedures were excluded from analysis. Demographic data, medical comorbidities, surgical variables, and various 30-day outcome measures were compared between the two groups. Multivariate logistic regression was used to identify independent variables associated with various outcome measure of interest. A total of 3120 patients were included in the final cohort: 1530 patients underwent tibia fixation alone and 1590 patients underwent both tibia and fibula fixation. The supplemental fibula fixation group had a higher rate of reoperation (2.3 % vs. 1.1 %, p = 0.013) and non-home discharge (14.8 % vs. 11.2 %, p = 0.003). The rate of surgical site infection was comparable between groups. Supplemental fibula fixation was independently associated with unplanned reoperation (RR: 1.939 [1.081-3.477], p = 0.026). Patients undergoing supplemental fibula fixation during tibial plafond ORIF had a higher rate of 30-day reoperation and non-home discharge. Supplemental fibula fixation during pilon fracture ORIF was independently associated with a higher rate of 30-day reoperation. There was no difference in the rates of surgical site infection or wound dehiscence between the two groups. 3.