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The value of fibular fixation in patients with stabilized distal tibia fractures

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

There is currently no consensus regarding the need for fixation of concomitant fibula fractures in patients with surgically treated distal tibia fracture. Although studies have shown it to be beneficial for fractures involving the syndesmosis, it remains unclear for suprasyndesmotic fractures. This study evaluates what effect the fixation of such suprasyndesmotic fibula fractures had on patients who underwent fixation of distal tibia fractures.

Methods

This retrospective cohort study included all consecutive adult patients who received surgical treatment for an extra-articular or simple intraarticular distal tibia fracture between 2012 and 2020 and had a concomitant fibula fracture proximal to the syndesmosis. Two groups were formed depending on whether the fibula was stabilized. The need for revision surgery, the occurrence of complications, fracture healing, rotational and angular malalignment were evaluated for both groups.

Results

This study included 120 patients, of which 40 (33.3%) had operative treatment of the fibula fracture. Of those with stabilized fibula fractures, 28 (70%) were treated with a plate and 12 (30%) with a titanium elastic nail. The group of patients with surgically treated fibula fractures had significantly more angular malalignments (10% vs 1.2%, p = 0.042), while there was no difference regarding rotational malalignment or fracture healing. Further, infections of the fibular surgical site occurred in 15% of surgically treated patients leading to significantly more revision surgeries in this group (40% vs 20%, p = 0.03). All infections occurred when a plate was used.

Conclusion

This study was unable to show any benefit from stabilizing concomitant, suprasyndesmotic fibula fractures in surgically treated distal tibia fractures. On the contrary, infection, revision surgery and angular malalignment were more frequent when the fibula was fixed. Therefore, such concomitant fibula fractures should not routinely be fixed and if stabilization is deemed necessary, the implant should be chosen carefully.

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All data is included in the manuscript.

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Funding

The authors declare that they received no funding for this project.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, Lucerne, Switzerland

    Nicole Maria van Veelen, Bryan Joost Marinus van de Wall, Nils Jan Bleeker, Isabelle Ruth Buenter, Björn-Christian Link, Reto Babst, Matthias Knobe & Frank Joseph Paulus Beeres

  2. Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland

    Reto Babst

Authors
  1. Nicole Maria van Veelen
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  2. Bryan Joost Marinus van de Wall
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  3. Nils Jan Bleeker
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  4. Isabelle Ruth Buenter
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  5. Reto Babst
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  6. Matthias Knobe
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  7. Frank Joseph Paulus Beeres
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Correspondence to Nicole Maria van Veelen.

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Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethics approval

This study was approved by the Swiss Association of Research Ethics Committees (approval number 2020–00694).

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Due to the retrospective nature of this study, the need for consent was waived by the Swiss Association of Research Ethics Committees.

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van Veelen, N.M., van de Wall, B.J.M., Bleeker, N.J. et al. The value of fibular fixation in patients with stabilized distal tibia fractures. Eur J Trauma Emerg Surg 48, 3257–3263 (2022). https://doi.org/10.1007/s00068-022-01888-0

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  • DOI: https://doi.org/10.1007/s00068-022-01888-0

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