Abstract:

Objective The management of distal third tibial fractures remain controversial. The aim of the present study was to evaluate whether concurrent fibular fixation changes union rates and aids in alignment in the case of distal third tibia fractures. Material and Method The study included 106 distal third tibia fracture operation cases in which the distance from the fracture to the plafond was between 3-12 cm at a single centre between January 2016 and June 2020. The patients were divided into three groups according to the status of the fibula: Group 1 (without fibular fixation with the presence of a fibula fracture, 47 cases), Group 2 (concurrent fibular fixation with the presence of a fibular fracture, 38 cases) and Group 3 (intact fibula, 21 cases). All fibular fixation surgeries were performed with locked plates (LCP) and tibial fixation with either LCP or intramedullary nailing (IMN). The primary outcome measures were union and alignment. Age, gender, AO classification, fibula fracture location, presence of an open fracture, implant type and time delay for surgery were also assessed. Results None of the variables except the presence of an open fracture was significant for the union rates or alignment. The union rate was significantly less if there was an open fracture in the concurrent fibular fixation group (p<0.001). Closed fractures were associated with better union rates according to the logistic regression analysis (OR=5,00 (%95 CI 2,24-11,48). Conclusion The present study suggests that a concurrent fibular fixation in the case of distal third tibia fractures improves neither the union rates nor the alignment. Therefore, we conclude that a fibular fixation is not a necessity in achieving better results and should not be performed in case of an open fracture considering the lesser union rate and the burden involved with an additional surgery.