The Influence of the Intact Fibula on the Compression of a Tibial Fracture or Pseudoarthrosis

Jørgensen, Torben Ejsing

doi:10.3109/17453677408989130

Cited by 15 publications

(8 citation statements)

References 12 publications

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“…10,50,51 An intact fibula may have an even greater effect on healing of distal tibia fractures 4,10,13,52 because of a relatively larger reduction in strain across the tibia fracture. 53,54 Some studies of nailing for distal tibia fractures with concurrent fibula fixation have reported little malalignment of the tibia, although up to 42% of patients had additional procedures to achieve fracture union. 13,20,44 Other reports of nailing in distal tibia fractures have shown greater rates of angular malalignment when the fibula is not routinely fixed.…”

Section: Discussionmentioning

confidence: 98%

Radiographic and Clinical Comparisons of Distal Tibia Shaft Fractures (4 to 11 cm Proximal to the Plafond): Plating Versus Intramedullary Nailing

Vallier

Bedi³

2008

Journal of Orthopaedic Trauma

230

176

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Objective: The purposes of this study were to review distal tibia shaft fractures treated with a plate or a nail and to assess the clinical and radiographic results, complication rates, and the need for secondary procedures.Design: Retrospective review.Setting: Two Level I trauma centers. Patient/Participants: We retrospectively reviewed 111 patientswith 113 extra-articular distal tibia fractures between 4 and 11 cm proximal to the plafond. Seventy-six were treated with an intramedullary nail and 37 were treated with a medial plate. Twenty-nine (27%) of the concomitant fibula fractures were fixed. Main Outcome Measurements: Complications and secondaryprocedures were evaluated in 111 patients after a mean of 24 months (range, 12-84 months).Results: A total of 111 patients with 113 fractures of the distal tibia were reviewed. Their mean age was 39.1 years, 69% were men, and 30% had open fractures. Four patients underwent additional procedures for soft tissue coverage. None of these had infection. Five patients (4.4%) developed osteomyelitis: four after intramedullary nailing (5.3%) and one after plating (2.7%). Nine patients (12%) had delayed union or nonunion after nailing. One patient (2.7%) had a nonunion after plating (P = 0.10). Nonunion was more common after concurrent fixation of the fibula (14% versus 2.6%, P = 0.04). Angular malalignment of $5 degrees occurred in 22 patients with nails (29%) and 2 with plates (5.4%, P = 0.003). Eight patients had malunions of $10 degrees. Valgus was the most common deformity (n = 16). Malunion was more common after open fracture (38%, P = 0.006) but was not related to fibula fixation. Painful hardware was removed in six patients (7.9%) with nails and in two patients (5.4%) with plates.Conclusions: Distal tibia fractures may be treated successfully with plates or nails. Delayed union, malunion, and secondary procedures were more frequent after nailing. Randomized prospective assessment may further clarify these issues and provide information about costs associated with these fractures.

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Section: Discussionmentioning

confidence: 98%

Radiographic and Clinical Comparisons of Distal Tibia Shaft Fractures (4 to 11 cm Proximal to the Plafond): Plating Versus Intramedullary Nailing

Vallier

Bedi³

2008

Journal of Orthopaedic Trauma

230

176

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“… 2 Jorgensen in their study revealed that in the presence of an intact fibula, a considerable fraction of force applied is spent in deforming the intact fibula before compressing the tibial fracture, thereby reducing the compressive force across the tibial fracture fragments. 3 They believed that the tibial fracture surfaces are held apart by the intact fibula. Teitz et al .…”

Section: Discussionmentioning

confidence: 99%

“…Most studies state the effect of intact fibula in closed ITS fractures only. 1 2 3 4 The primary aim of our study was to study the effect of the intact fibula in ITS fractures in closed and open injuries and whether these fractures can unite without a primary fibulectomy. We have studied the effect of an intact fibula on the duration of healing for closed and open isolated fractures of tibial shaft.…”

Section: Introductionmentioning

confidence: 99%

The effect of intact fibula on functional outcome of reamed intramedullary interlocking nail in open and closed isolated tibial shaft fractures: A prospective study

Balaji¹,

Chandra²,

Devadoss³

et al. 2016

IJOO

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Background:Isolated tibial shaft (ITS) fracture with intact fibula is a common injury but records often fail to mention it. Our primary aim was to study the effect of the intact fibula in ITS fractures in closed and open injuries and that these fractures can unite without a primary fibulectomy.Materials and Methods:56 patients who sustained an ITS fracture with an intact fibula who underwent closed or open reduction and reamed intramedullary interlocking nailing (IM IL nail) for closed and open fractures between August 2008 and April 2014 were included in this study. Four patients were lost to followup. One patient died due to causes not related to the surgery. At the time of final followup, 51 patients with 51 ITS fractures were available for the analysis. There were 33 closed and 18 open fractures. Patients were followed up at 4 weekly intervals until radiological signs of union were noted. They were assessed for functional outcome using the IOWA knee and ankle score systems at the time of final followup.Results:The average time to union was 19.7 weeks. Closed fractures united in 17.7 weeks as compared to 23.5 weeks for open fractures (P < 0.05). A delay in union occurred in 6 patients (4 open) and in 3 patients fractures failed to unite (2 open). The functional outcome as per the knee score and ankle score evaluation system was 93.13 and 92.54, respectively. The knee scores were 93.81 and 91.8 for closed and open ITS fractures, respectively (P > 0.05). Similarly, the ankle scores were 94.96 and 88.1 for closed and open ITS fractures, respectively (P < 0.05).Conclusion:ITS fracture with intact fibula is a common occurrence, and they can be treated safely with reamed IM nailing that provides good union rates and the excellent functional result even in open fractures.

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“…It has been reported that 5 mm distraction of the fracture line in tibial fractures can prolong union to 8-12 months [12]. Isolated tibial fractures have been examined in literature and it has been reported that union problems have been experienced [13,14]. In a study by Court Brown et al [6], 14 isolated tibial fractures were compared with cases of both bone fractures and a significant difference was determined in the time to union (16.7 weeks vs.15.6 weeks).…”

Section: Discussionmentioning

confidence: 99%

Effect of anatomic fibula on tibia union and alignment after intramedullary nailing of tibia shaft fractures

Evren¹,

Yaradılmış²,

Okkaoğlu³

et al. 2020

The European Research Journal

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Objectives: The effect of an intact or fixated fibula on tibial union and alignment in tibial shaft fractures applied with intramedullary nailing is investigated. Methods: A retrospective examination was made of 67 patients aged 19-85 years who were applied with intramedullary nailing for a tibial shaft fracture (AO-42) between January 2010 and December 2016. The 44 patients included in the study were separated into 2 groups as those with anatomic fibula (Group 1, n = 12) and those with a fibula fracture which is not fixated (Group 2, n = 32). The patients were evaluated in respect of bone union and malalignment from direct radiographs. Union was evaluated according to the RUST criteria, and the threshold for malalignment was taken as 5˚ in the coronal and sagittal planes. Results: The patients comprised 24 males and 20 females (M/F: 6/5) with a mean age of 42.7 years (range, 19-76 years). Non-union was observed in 3/12 patients (25%) in Group 1, and in 2/32 (6.3%) patients in Group 2 at 6 months. Malalignment was observed in 1/12 (8.3%) patients in Group 1 (procurvatum) and in 7/32 (21.8%) patients in Group 2, of which 3 (9.3%) were varus, and 4 (12.5%) were valgus. The rate of malalignment was significantly lower in Group 1 than in Group 2. Conclusions: The results demonstrated that bone union of a tibial shaft fracture is slower in patients with an anatomic fibula compared to those with non-anatomic fibula. Although the anatomic fibula slows the rate of union, it prevents malalignment.

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The Influence of the Intact Fibula on the Compression of a Tibial Fracture or Pseudoarthrosis

Cited by 15 publications

References 12 publications

Radiographic and Clinical Comparisons of Distal Tibia Shaft Fractures (4 to 11 cm Proximal to the Plafond): Plating Versus Intramedullary Nailing

Radiographic and Clinical Comparisons of Distal Tibia Shaft Fractures (4 to 11 cm Proximal to the Plafond): Plating Versus Intramedullary Nailing

The effect of intact fibula on functional outcome of reamed intramedullary interlocking nail in open and closed isolated tibial shaft fractures: A prospective study

Effect of anatomic fibula on tibia union and alignment after intramedullary nailing of tibia shaft fractures

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