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Abstract. Objectives:. To determine whether patients with AO/OTA 43-B anterior impaction tibial plafond fractures have worse clinical outcomes, and an increased risk of progression to ankle arthrodesis. Design:. Retrospective cohort study. Setting:. Level 1 academic trauma center. Patients:. One hundred sixty-eight patients were included in the study, all of whom had tibial plafond fractures. Intervention:. Study patients underwent external fixation and/or open reduction internal fixation (ORIF) as indicated by fracture/injury pattern. Main outcome measurements:. Arthrodesis rate. Results:. AO 43-B Anterior impaction tibial plafond fractures have an increased risk of progression to arthrodesis when compared to AO 43-B nonanterior impaction type fractures (19.4% vs 8%). Conclusions:. AO 43-B anterior impaction tibial plafond fractures have a worse clinical outcome compared to AO 43-B nonanterior impaction fractures. These fractures also confer increased risk of progression to arthrodesis. The authors have no conflict of interests to declare.