The role of fibular fixation in the treatment of tibia diaphysis distal third fractures

Abstract

Introduction: Combined fractures of the distal third of tibia diaphysis and fibula diaphysis are a common orthopedic injury. There is an ongoing debate about the necessity of fibular fixation when associated to distal third tibial fracture. This study aims at evaluating the role of fibular fixation in the treatment of distal third tibial fractures. Hypothesis: We hypothesized that fixation of the fibula increases the stability of fixation in distal third tibial and fibular fractures. Materials and methods: In a randomized clinical trial, 53 patients with concomitant fractures of tibia and ipsilateral fibula at distal third level were recruited in this study during a 23-month period. Patients were randomized in two groups: patients with fibular fixation (case group) and without fibular fixation (control group). The patients were followed up for at least 6 months postoperatively. Results: There were seven cases exhibiting malalignment on immediate postoperative radiographs. Six of them were in group II (control group) and one was in group I (case group) (P = 0.084). We didn't find nonunion in group I and we found three patients in group II (P = 0.141). Infection was one in group I and two in group II on gustillo II injuries (P = 0.516). Conclusion: Despite its low count of patients, our study didn't show any advantage to fix the fibula fracture associated to distal third of tibia diaphysis fracture. It didn't show either an increase of complication after fibula open reduction and internal fixation. Level of evidence: Level III. Randomized prospective study. (C) 2012 Elsevier Masson SAS. All rights reserved.