title: Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures?
abstract: OBJECTIVE
  Evaluate whether supplementary fibular fixation helped maintain axial alignment in distal metaphyseal tibia-fibula fractures treated by locked intramedullary nailing.
  
  
  METHODS
  Retrospective chart and radiographic review.
  
  
  METHODS
  Three, level 1, trauma centers.
  
  
  METHODS
  Distal metaphyseal tibia-fibula fractures were separated into 2 groups based on the presence of adjunctive fibular plating. Group 1 consisted of fractures treated with small fragment plate fixation of the fibula and intramedullary (IM) nailing of the tibia, whereas group 2 consisted of fractures treated with IM nailing of the tibia without fibular fixation.
  
  
  METHODS
  Malalignment of the tibial shaft was defined as 1) >5 degrees of varus/valgus angulation, or 2) >10 degrees anterior/posterior angulation. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 6-month follow-up. Leg length and rotational deformity were not examined.
  
  
  RESULTS
  Seventy-two fractures were studied. In 25 cases, the associated fibula fracture was stabilized, and in 47 cases the associated fibula fracture was not stabilized. Cases were more likely to have the associated fibula fracture stabilized where the tibia fracture was very distal. In multivariate adjusted analysis, plating of the fibula fracture was significantly associated with maintenance of reduction 12 weeks or later after surgery (odds ratio = 0.03; P = 0.036). The use of 2 medial-lateral distal locking bolts also was protective against loss of reduction; however, this association was not statistically significant (odds ratio = 0.29; P = 0.275).
  
  
  CONCLUSIONS
  In this study, the proportion of fractures that lost alignment was smaller among those receiving stabilization of the fibula in conjunction with IM nailing compared with those receiving IM nailing alone. Adjunctive fibular stabilization was associated significantly with the ability to maintain fracture reduction beyond 12 weeks. At the present time, the authors recommend fibular plating whenever IM nailing is contemplated in the unstable distal tibia-fibular fracture.
authors.affiliation: Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, New York, NY 10003, USA. kenneth.egol@nyumc.org
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
authors.forename: Russell
authors.initials: R
authors.lastname: Weisz
authors.forename: Rudi
authors.initials: R
authors.lastname: Hiebert
authors.forename: Nirmal C
authors.initials: NC
authors.lastname: Tejwani
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Koval
authors.forename: Roy W
authors.initials: RW
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017760:Bone Malalignment / Q000209:etiology / Q000517:prevention & control*; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005360:Fibula / Q000293:injuries*; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*