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Intramedullary tibial nailing of distal tibiofibular fractures: additional fibular fixation or not?

  • M. Van Maele
  • B. Molenaers
  • E. Geusens
  • S. Nijs
  • H. Hoekstra
Original Article
  • 213 Downloads

Abstract

Introduction

The anatomy of the distal tibia accounts for reduced biomechanical stability and higher complication rates when treating distal tibiofibular fractures with an intramedullary tibia nail (IMTN). The goal of this study was to identify variables that affect the stability of IMTN. We assessed the value of additional fibular fixation, angular stable interlocking screws (ASLS) and multiplanar screw configuration in IMTN.

Patients and methods

A retrospective cohort study was performed including 184 distal tibial fractures and associated fibula fracture treated with IMTN. Relevant demographic, fracture-related (type and level of the tibia and fibula fracture) and operative variables (depth of the nail, screw type and configuration, use of polar screws, fibular fixation) were studied. Coronal and sagittal alignment was assessed directly and 3–6 months after IMTN. Loss of reduction (LOR) was classified as 5–9° or ≥10°.

Results

48.4% of the patients showed ≥5° LOR in one or both planes. Coronal LOR 5°–9° significantly correlated with low tibial fractures (p = 0.034), AO/OTA type 43 distal tibial fractures (p = 0.049), and sagittal LOR 5°–9° (p = 0.015). Although sagittal LOR 5°–9° was associated with fibular fractures (non-fixated suprasyndesmotic, p = 0.011), conversely we could not demonstrate the added value of (suprasyndesmotic) fibula fixation in IMTN. Coronal LOR ≥10° significantly correlated with AO/OTA type 43 distal tibial fractures (p = 0.009). In contrast to multiplanar configuration, we found a clear benefit of ASLS in distal IMTN locking.

Conclusions

The level of the tibial fracture (AO/OTA type) and (suprasyndesmotic) fibular fractures were the main determinants of LOR after IMTN. ASLS was found to increase the stability of IMTN. Due to heterogeneity, however, we could not demonstrate the value of fibular fixation in IMTN. Therefore, a future prospective study with uniform treatment strategy for IMTN of distal tibiofibular fractures, with or without fixation of the fibula, is mandatory.

Keywords

Distal tibial fractures Fibular fixation Outcome 

Abbreviations

LOR

Loss of reduction

ASA-score

American Society of Anesthesiologists physical status score

IMTN

Intramedullary tibia nailing

ASLS

Angular stable locking system

PO

Postoperative

FU

Follow-up

Notes

Compliance with ethical standards

Conflict of interest

Margaux Van Maele, Ben Molenaers, Eric Geusens, Stefaan Nijs, and Harm Hoekstra declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • M. Van Maele
    • 1
  • B. Molenaers
    • 2
  • E. Geusens
    • 3
  • S. Nijs
    • 4
    • 5
  • H. Hoekstra
    • 4
    • 5
  1. 1.Faculty of MedicineKU Leuven, University of LeuvenLeuvenBelgium
  2. 2.Department of Orthopaedic SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  3. 3.Department of RadiologyUniversity Hospitals LeuvenLeuvenBelgium
  4. 4.Department of Trauma SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  5. 5.Department of Development and RegenerationKU Leuven, University of LeuvenLeuvenBelgium

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