Ufuk ARZU, Batuhan GENCER, Mehmet CANŞI, Mohammed N. M. ZIARA, Deniz GÜLABİ
Comprehensive Medicine - 2026;18(2):175-186
Objective: Distal tibial metaphyseal fractures present significant clinical challenges due to complex fracture patterns, limited soft-tissue coverage, and compromised vascularity. This study aimed to investigate the effect of medial plate positioning on postoperative complications and to identify predictors of nonunion and soft-tissue complications following medial plating. Materials and Methods: A retrospective study was conducted on 78 adult patients who underwent medial distal tibial plate fixation for distal tibial metaphyseal fractures between 2016 and 2024. Demographic, fracture-related, and surgical parameters were analyzed. Radiographic assessments included measurement of plate level relative to the ankle joint and medial malleolus using standardized ratio-based methods. Outcomes included union, deformity, and soft-tissue complications. Results: Soft-tissue complications occurred in 23.1% of patients and were significantly associated with open fractures (p=0.012), staged treatment (p=0.008), and lower union rates (p=0.026). Plate level ratios (b/a, c/a) showed no association with soft-tissue complications. Nonunion occurred in 14.1% of patients and was significantly associated with left-sided fractures (p=0.018), AO type A patterns (p=0.003), and the presence of varus deformity at final follow-up (p=0.002). Plate position and plate level ratios were not predictive of nonunion (p>0.05). Conclusion: In distal tibial metaphyseal fractures, the level of medial plate placement was not associated with soft-tissue complications or nonunion. In contrast, open injury, treatment stage, fracture type, and residual varus deformity were identified as the primary determinants of adverse outcomes. These factors should therefore be considered during surgical planning and postoperative follow-up.
