Distal leg fractures: How critical is the fibular fracture and its fixation?
BACKGROUND
Extra-articular distal tibia fractures include a tibial fracture line located partially or totally in the metaphyseal bone and a fibular fracture in variable areas or sometimes absent. There is no consensus in the literature on the conduct to address the fibula fracture. The main objective of this study was to assess its impact on tibial reduction and union.


OBJECTIVE
Fibular fixation plays a positive role in reducing tibial displacement and improving mechanical stability of the entire lesion.


METHODS
This study was based on the multicenter observational group of the 2009 SOFCOT symposium, i.e., 142 metaphyseal fractures of the tibia. The fibula was intact in 10 cases and fractured in 132. In the three main categories of surgical treatment for the tibia (nailing, plating, external fixation) (126 fractures), the fibular lesion was not treated in 79 cases (61%) in this series, nine were treated with intramedullary pinning, and 38 with plate and screw fixation.


RESULTS
There was no statistical relation between the anatomic situation of the diaphysis and the anatomic type of the fibular fracture or between the anatomic type of the fibular fracture and its situation compared to the tibial fracture line. The intertubercular and neck fractures were type A1 or B1 (P<0.001) and were combined to a tibia fracture with a torsional component; the medial-diaphyseal and subtubercular fractures were associated with tibial fracture lines with a simple transversal or comminution or metaphyseal-diaphyseal component (P<0.032). The rate of pseudarthrosis of the fibular fracture was 4.7% at 1 year; in all these cases, fibular treatment had been conservative. All treatments combined, the tibial axes were statistically better corrected when the fibula was treated with fixation. In four of the 11 cases of axial tibial malunion, the primary fibular fixation caused or worsened them.


CONCLUSIONS
The present clinical series provides results similar to the biomechanical studies. The consequences of fibular fixation perpetuating a tibia reduction abnormality or on the contrary the absence of fibular fixation appeared as probable factors of residual reduction defects, lack of stability of the tibiofibular complex, and tibia non-union.


METHODS
Level IV (prospective cohort study).
Bonnevialle
P
P
The Musculo skeletal Institute, Toulouse Teaching Hospital Center, Purpan Orthopaedics and Traumatology Unit, place Baylac, Toulouse 31052 cedex, France. bonnevialle.p@chu-toulouse.fr
Lafosse
J-M
JM
Pidhorz
L
L
Poichotte
A
A
Asencio
G
G
Dujardin
F
F
D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000209:etiology; D016267:External Fixators; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing / Q000502:physiology; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000209:etiology*; D005602:France; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011446:Prospective Studies; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*