Skip to main content

Advertisement

SpringerLink
Log in

The role of fibula fixation in combined distal-third tibia and fibula fractures: a systematic literature review

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

The role of concomitant fibula fracture fixation in distal-third tibia fractures regarding alignment, union, and functional outcome is still a topic of debate. In this review, we summarize the available comparative literature regarding fibula fixation in distal third lower leg fractures.

Materials and methods

A systematic literature review of articles published between January 2000 and January 2022 in the PubMed, Cochrane, and EMBASE databases about this topic was performed.

Results

746 unique studies were identified of which four randomized-controlled trials and six retrospective studies were included. Nine studies compared alignment after tibia fixation with or without fibula fixation, six studies reported on tibial union, and three studies reported on functional outcome between groups. Pooling of data was not possible due to varying outcome measures and inclusion criteria. Fibula fixation was associated with less rotational malalignment, while there does not seem to be consensus regarding the effect on sagittal and coronal alignment. Six studies reported on the effect of fibula fixation on tibial union. None of these studies found a significant difference between treatment modalities. Furthermore, one out of three studies reporting functional outcome described a marginal beneficial functional outcome after fibula fixation. Ultimately, no differences in complication rates between treatment modalities were described.

Conclusion

Fixation of the fibula in distal-third lower leg fractures does not seem to have a significant effect on coronal and sagittal tibial alignment. Furthermore, fibula fixation is associated with significantly less rotational malalignment, although the clinical importance of this finding is questionable as true differences in rotational alignment between treatment modalities are small. Finally, fibula fixation does not affect union, functional outcome, or complication rate as adjuvant to tibia fixation.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

All data supporting the findings of this study are available within the paper.

References

  1. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697

    Article  PubMed  Google Scholar 

  2. Leliveld MS, Polinder S, Panneman MJM, Verhofstad MHJ, Van Lieshout EMM (2020) Epidemiologic trends for isolated tibia shaft fracture admissions in The Netherlands between 1991 and 2012. Eur J Trauma Emerg Surg 46(5):1115–1122

    Article  PubMed  Google Scholar 

  3. Torino D, Mehta S (2016) Fibular fixation in distal tibia fractures: reduction aid or nonunion generator? J Orthop Trauma 30(Suppl 4):S22–S25

    Article  PubMed  Google Scholar 

  4. Galbraith JG, Daly CJ, Harty JA, Dailey HL (2016) Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing. Clin Biomech Bristol Avon 38:42–49

    Article  Google Scholar 

  5. Morin PM, Reindl R, Harvey EJ, Beckman L, Steffen T (2008) Fibular fixation as an adjuvant to tibial intramedullary nailing in the treatment of combined distal third tibia and fibula fractures: a biomechanical investigation. Can J Surg J Can Chir 51(1):45–50

    Google Scholar 

  6. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 29(372):n71

    Article  Google Scholar 

  7. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  Google Scholar 

  8. Prasad M, Yadav S, Sud A, Arora NC, Kumar N, Singh S (2013) Assessment of the role of fibular fixation in distal-third tibia-fibula fractures and its significance in decreasing malrotation and malalignment. Injury 44(12):1885–1891

    Article  PubMed  Google Scholar 

  9. Pogliacomi F, Schiavi P, Calderazzi F, Ceccarelli F, Vaienti E (2019) When is indicated fibular fixation in extra-articular fractures of the distal tibia? Acta Biomed Atenei Parm 89(4):558–563

    Google Scholar 

  10. Taylor BC, Hartley BR, Formaini N, Bramwell TJ (2015) Necessity for fibular fixation associated with distal tibia fractures. Injury 46(12):2438–2442

    Article  Google Scholar 

  11. Kariya A, Jain P, Patond K, Mundra A (2020) Outcome and complications of distal tibia fractures treated with intramedullary nails versus minimally invasive plate osteosynthesis and the role of fibula fixation. Eur J Orthop Surg Traumatol Orthop Traumatol 30(8):1487–1498

    Article  Google Scholar 

  12. Javdan M, Tahririan MA, Nouri M (2017) The role of fibular fixation in the treatment of combined distal tibia and fibula fracture: a randomized. Control Trial Adv Biomed Res 6:48

    PubMed  Google Scholar 

  13. Rouhani A, Elmi A, Akbari Aghdam H, Panahi F, Dokht GY (2012) The role of fibular fixation in the treatment of tibia diaphysis distal third fractures. Orthop Traumatol Surg Res OTSR 98(8):868–872

    Article  CAS  PubMed  Google Scholar 

  14. Egol KA, Weisz R, Hiebert R, Tejwani NC, Koval KJ, Sanders RW (2006) Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures? J Orthop Trauma 20(2):94–103

    Article  PubMed  Google Scholar 

  15. Bonnevialle P, Lafosse JM, Pidhorz L, Poichotte A, Asencio G, Dujardin F et al (2010) Distal leg fractures: how critical is the fibular fracture and its fixation? Orthop Traumatol Surg Res OTSR 96(6):667–673

    Article  CAS  PubMed  Google Scholar 

  16. Van Maele M, Molenaers B, Geusens E, Nijs S, Hoekstra H (2018) Intramedullary tibial nailing of distal tibiofibular fractures: additional fibular fixation or not? Eur J Trauma Emerg Surg Off Publ Eur Trauma Soc 44(3):433–441

    Article  Google Scholar 

  17. Berlusconi M, Busnelli L, Chiodini F, Portinaro N (2014) To fix or not to fix? The role of fibular fixation in distal shaft fractures of the leg. Injury 45(2):408–411

    Article  CAS  PubMed  Google Scholar 

  18. De Giacomo AF, Tornetta P (2016) Alignment after intramedullary nailing of distal tibia fractures without fibula fixation. J Orthop Trauma 30(10):561–567

    Article  PubMed  Google Scholar 

  19. Ehlinger M, Adam P, Gabrion A, Jeunet L, Dujardin F, Asencio G et al (2010) Distal quarter leg fractures fixation: the intramedullary nailing alone option. Orthop Traumatol Surg Res OTSR 96(6):674–682

    Article  CAS  PubMed  Google Scholar 

  20. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA (2005) Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Jt Surg Am 87(6):1213–1221

    Google Scholar 

  21. Kim RG, An VVG, Petchell JF (2021) Fibular fixation in mid and distal extra-articular tibia fractures—a systematic review and meta-analysis. Foot Ankle Surg [Internet]. 2021. https://www.sciencedirect.com/science/article/pii/S1268773121002186. Accessed 11 Mar 2022

  22. Frodl A, Erdle B, Schmal H (2021) Osteosynthesis or non-operative treatment of the fibula for distal lower-leg fractures with tibial nailing: a systematic review and meta-analysis. EFORT Open Rev 6(9):816–822

    Article  PubMed  PubMed Central  Google Scholar 

  23. Peng J, Long X, Fan J, Chen S, Li Y, Wang W (2021) Concomitant distal tibia-fibula fractures treated with intramedullary nailing, with or without fibular fixation: a meta-analysis. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg 60(1):109–113

    Article  Google Scholar 

  24. Li C, Li Z, Wang Q, Shi L, Gao F, Sun W (2021) The role of fibular fixation in distal tibia-fibula fractures: a meta-analysis. Adv Orthop 25(2021):e6668467

    Google Scholar 

Download references

Funding

No funding was received for the realization of this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Haaglanden Medical Center, Secretariaat Heelkunde F1.31, Lijnbaan 12, 2512VA, The Hague, The Netherlands

    Victor Franciscus Palm, Jochem Maarten Hoogendoorn & Samuel Marinus Verhage

Authors
  1. Victor Franciscus Palm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jochem Maarten Hoogendoorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samuel Marinus Verhage
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor Franciscus Palm.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

No studies with human participants or animals performed by any of the authors were used for the realization of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palm, V.F., Hoogendoorn, J.M. & Verhage, S.M. The role of fibula fixation in combined distal-third tibia and fibula fractures: a systematic literature review. Arch Orthop Trauma Surg 144, 219–228 (2024). https://doi.org/10.1007/s00402-023-05092-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-05092-6

Keywords

Search

Navigation