Article
Is the fixation of concomitant fibula fractures necessary in surgically treated distal tibia fractures?
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Authors
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Nicole Van Veelen
- Luzerner Kantonsspital, Department of Orthopaedic and Trauma Surgery, Luzern, Switzerland
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Frank Beeres
- Luzerner Kantonsspital, Department of Orthopaedic and Trauma Surgery, Luzern, Switzerland
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Nils Jan Bleeker
- Amsterdam University Medical Centers, Department of Orthopaedic Surgery, Amsterdam, Netherlands
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Isabelle Bünter
- Luzerner Kantonsspital, Department of Orthopaedic and Trauma Surgery, Luzern, Switzerland
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Matthias Knobe
- Luzerner Kantonsspital, Department of Orthopaedic and Trauma Surgery, Luzern, Switzerland
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Björn-Christian Link
- Luzerner Kantonsspital, Department of Orthopaedic and Trauma Surgery, Luzern, Switzerland
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Reto Babst
- Luzerner Kantonsspital, Department of Orthopaedic and Trauma Surgery, Luzern, Switzerland
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Bryan van de Wall
- Luzerner Kantonsspital, Department of Orthopaedic and Trauma Surgery, Luzern, Switzerland
| Published: | October 26, 2021 |
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Outline
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Objectives: To date there is no consensus on whether or not concomitant fibula fracture without syndesmotic involvement need to be fixed in surgically treated distal tibia fractures. The aim of this study was to evaluate the benefits and risks of the stabilization of such fibula fractures.
Methods: This retrospective cohort study included all consecutive adult patients treated surgically for distal tibia fractures with a concomitant fibula fracture proximal to the syndesmosis (AO 42-A, 42-B, 42-C, 43-A). Two groups were made based on whether the fibula was stabilized or not. Fibula fixation was generally performed if a reference for the length of the tibia was required or in order to augment stability in case of plate fixation of the tibia. Fracture healing, angular and rotational malalignment and complications were evaluated for both groups.
Results and Conclusion: In total 120 patients were included in the study, of which 80 (66.7%) had non-operative treatment of the fibula fracture. Of the patients with stabilized fibula fractures, 12 (30%) were fixed with a titanium elastic nail and 28 (70%) with a plate. There were significantly more angular malalignments in the surgically treated group (10% vs 1.2%, p=0.042), while there was no difference concerning rotational malalignment or fracture healing. Further, infections of the fibular surgical site occurred in 15% of surgically treated patients leading to significantly more revision surgeries in this group (40% vs 20%, p=0.03). All infections occurred when a plate was used.The cohort only included a small number of complex fractures, therefore a subgroup analysis for fracture types (A/B vs C) was not possible.
This study could not show any benefit from stabilizing concomitant, non-syndesmotic fibula fractures in surgically treated distal tibia fractures. On the contrary, angular malalignment, infection and revision surgery occurred more often when the fibula was fixed. Therefore, such concomitant fibula fractures should not routinely be fixed and if stabilization is deemed necessary, the required implant should be chosen carefully.
