Fibular fixation as an adjuvant to tibial intramedullary nailing in the treatment of combined distal third tibia and fibula fractures : a prospective observational study

Distal 1/3rd extraarticular tibia fractures are common in trauma centers. It is often the result of high energy trauma,usually associated with distal fibular fractures. Tibia interlocking nail is an established way of treating these fractures. Fixation of fibular fractures in distal tibial metaphyseal fractures is controversial, although fixation of the fibular fracture by a plate partially stabilizes fractures of the distal tibial shaft and considered in distal tibial fractures treated with intramedullary fixation to prevent valgus deformity even there is increased potential for delaying the tibial fracture healing. Objectives: The purpose of this study was to compare the functional and radiological outcome of fractures of distal third tibia and fibula treated by interlocking nail of tibia with fibular plating and without fibular plating. Material and Methods: A total of 48 patients who had fractures of lower third tibia and fibula are included in this study. 48 patients were divided into two groups I and II (24 patients in each group) based on fibular fixation. Results: Functional results were evaluated based on radiological and biological union and absence or presence of complications. In Group A 3 out of 22 patients (13%) showed non union and in Group B 2 out of 21 patients (9%). In Group A 2 out of 22 patients (9%) showed malunion at end of 6 months and in Group B 3 out of 21 patients (8%). In Group A 15 out of 22 patients (68.8%) showed union at end of 6 months without complications and in Group B 14 out of 21 patients (66.66%).Conclusion: Based on the results of the study, it was concluded that union occurred in both groups where fibula was fixed and not fixed with same rates of complications in both groups except infection which was higher in fibula plating cases. In cases where fibula fixation wasn’t planned and distal tibia reduction was achieved using percutaneous clamp.If intraoperatively,reduction wasn’t possible it was seen that if fibula was fixed first then better reduction was achieved. A long term study is required for further exploration on indications of fibular plating in distal fractures of tibia