• Noelle L Van Rysselberghe, Sean T Campbell, L Henry Goodnough, Brett P Salazar, Julius A Bishop, Michael J Bellino, Justin F Lucas, and Michael J Gardner.
• Stanford University Department of Orthopaedic Surgery, 300 Pasteur Dr, Edwards Building, R144, Stanford, CA, 94305, USA. Electronic address: nvanry@stanford.edu.
• Injury. 2021 Apr 1; 52 (4): 977-981.

ObjectiveTo assess the relationship between metaphyseal callus formation and preservation of distal tibial alignment in pilon fractures treated with internal plate fixation.DesignRetrospective Review SETTING: Academic Level I Trauma Center PATIENTS: Forty-two patients with AO/OTA type C2 or C3 pilon fractures treated with plate fixation.InterventionInternal fixation with anterolateral plating, medial plating, or both. Modified Radiographic Union Score in Tibial fracture (mRUST) scores were determined from six-month radiographs.Main Outcome MeasurementsChange in lateral and anterior distal tibial angles (LDTA and ADTA) at six months post-operatively.ResultsHigh callus formation (mRUST ≥ 11 at six months) was associated with a greater loss of coronal reduction as measured by LDTA compared to low callus formation (mRUST < 11): 3.8 vs 2.1° (p = .019), with no difference in ADTA change between groups. In a multivariable logistic regression controlling for age, smoking, obesity, and open fracture, higher mRUST scores were a predictor of coronal reduction loss of five or more degrees (OR 1.71, p=.039). Dual column plating did not independently predict maintenance of alignment.ConclusionsRecent literature has popularized dual column fixation for pilon fractures, but it remains unknown whether increased metaphyseal stiffness enhances or impairs healing. In this series, decreased metaphyseal callus formation was associated with maintained coronal alignment, suggesting that a stiffer mechanical environment may be preferable to prevent short term reduction loss in these complex injuries.Level Of EvidenceIII.Copyright © 2020 Elsevier Ltd. All rights reserved.

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