title: The effect of intact fibula on functional outcome of reamed intramedullary interlocking nail in open and closed isolated tibial shaft fractures: A prospective study.
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedics, Devadosss Multispeciality Hospital, Institute of Orthopaedic Research and Accident Surgery, Madurai, Tamil Nadu, India.
authors.forename: S Muthukumar
authors.initials: SM
authors.lastname: Balaji
authors.affiliation: Department of Orthopaedics, Devadosss Multispeciality Hospital, Institute of Orthopaedic Research and Accident Surgery, Madurai, Tamil Nadu, India.
authors.forename: P Madhu
authors.initials: PM
authors.lastname: Chandra
authors.affiliation: Department of Orthopaedics, Devadosss Multispeciality Hospital, Institute of Orthopaedic Research and Accident Surgery, Madurai, Tamil Nadu, India.
authors.forename: Sathish
authors.initials: S
authors.lastname: Devadoss
authors.affiliation: Department of Orthopaedics, Devadosss Multispeciality Hospital, Institute of Orthopaedic Research and Accident Surgery, Madurai, Tamil Nadu, India.
authors.forename: A
authors.initials: A
authors.lastname: Devadoss
keywords: Fibulectomy; Fracture; bone; fibula; fracture fixation; intact fibula; intramedullary; isolated tibial shaft fracture; reamed intramedullary nailing; tibial fracture