Purpose: To determine if union could be achieved in peri-plafond tibial fractures by using a fibular plate with the screws brought all the way across to the medial tibial cortex.

Materials & Methods: Between September 1994 and March 2000, five patients were treated with this technique with autologous bone grafting with or without a tibial buttress plate. All of the fractures were within 2cm of the tibial plafond, thereby preventing adequate fixation with a tibial plate alone. The preoperative diagnoses included infected distal tibial nonunion (3 cases), a distal tibial nonunion (1 case), and distal tibial malunion (1 case). All had associated fibular involvement. The patients had undergone 12 prior operations. Their average age was 59 years. All patients healed without additional surgery and all were pleased with their procedure.

Conclusion: The difficulty in obtaining fixation of a periplafond tibial nonunion with fibular involvement was solved using rigid internal fixation via a fibular plate with the screws brought entirely across the tibia. All five patients achieved osseous union and stability and functionally were able to walk with minimal or no discomfort and required no ambulatory aides.