Distal leg fractures: How critical is the fibular fracture and its fixation?

Bonnevialle, P.; Lafosse, J.-M.; Pidhorz, L.; Poichotte, A.; Asencio, G.; Dujardin, F.

doi:10.1016/j.otsr.2010.07.002

Cited by 33 publications

(17 citation statements)

References 26 publications

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“…Though metaphyseal tibial fractures rarely occur with fibular fractures [3], fibular fractures with distal, diaphyseal tibia fractures, that are mainly located in the supratubercular or media diaphyseal regions have an incidence of > 75% [4]. Surgical treatment of distal tibiofibular fractures with intramedullary nailing (IMN) is the preferred method of repair [5], even in very distal fractures [6].…”

Section: Introductionmentioning

confidence: 99%

Complications after surgical management of distal lower leg fractures

Neumann

Strohm

Reising

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundOsseous healing of distal lower leg fractures can be prolonged and is often associated with wound healing problems because of the marginal soft - tissue and vascular supply in this area. Postoperative complications are frequent, and according to the literature, open reduction and plate fixation is thought to be associated with higher complication rates. The objective of this study was to evaluate the most common postoperative complications following intramedullary nailing or plate osteosynthesis of distal lower leg injuries with a focus on combined tibio-fibular fractures. The outcomes of patients with and without complications associated the two surgical techniques were compared.MethodsDuring a 5-year period, all surgically treated distal tibiofibular fractures were retrospectively collected from the clinical database and were evaluated for the presence of postoperative complications which included compartment syndrome, wound infection, delayed union and non-union, synostosis and rotational malalignment. Postoperative complications were reviewed and correlated with patient risk factors.ResultsA total of 199 patients were included in the study, and 75 complications were reported. The majority of complications were associated with closed fracture types treated with intramedullary nailing, delayed union being the most frequent. For open fractures, surgical treatment with plate fixation had a complication rate of 12% compared with 25% after intramedullary nailing.DiscussionIn general, distal lower leg fractures are associated with a high risk of postoperative complications. Distal diaphyseal tibial fractures that have been treated with intramedullary nailing devices have a higher risk of delayed union or non - union.ConclusionPlate fixation in distal metaphyseal fractures has a higher risk of problems related to wound healing and postoperative wound infections.

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Section: Introductionmentioning

confidence: 99%

Complications after surgical management of distal lower leg fractures

Neumann

Strohm

Reising

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…6). Un autre facteur augmentant la stabilité de la fracture est l'ostéosynthèse de la fibula, comme l'ont rappelé récemment Bonneviale et al [9]. Elle doit être proposée facilement voire systématiquement dans notre expérience : au minimum par une broche d'alignement, voire une ostéosynthèse par plaque vissée.…”

Section: Fixation Externeunclassified

Prise en charge initiale des fractures ouvertes de jambe

Nen

2012

Réparations Tissulaires À La Jambe

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Une fracture ouverte de jambe témoigne d'un traumatisme brutal, responsable de lésions souvent pluritissulaires qui peuvent grever la fonction du membre. Quel que le stade d'ouverture, elle reste une urgence chirurgicale, exigeant une équipe entraînée [1]. Plutôt que de « fracture ouverte de jambe », le terme de « traumatisme ouvert de jambe » prendrait mieux en compte l'aspect potentiellement pluritissulaire de telles lésions, sans fixer le chirurgien sur le seul élément radiovisible, l'os, et reléguer en arrière-plan la prise en charge cutanée. L'ouverture attire d'emblée l'attention sur un élément pronostique potentiellement grave : la communication du tibia avec l'extérieur. Mais le bilan ne doit par s'arrêter à ce clin d'oeil furtif, il doit rechercher par la palpation protégée un décollement sous-cutané et son étendue en particulier, et juger la contusion associée qui peut d'ailleurs exister lors de fractures fermées. L'absence de parallélisme strict entre lésions osseuses et des parties molles prouve à quel point il n'existe pas de stéréotype : un gros délabrement cutanéo-musculaire peut s'associer à une fracture transversale simple du tibia, comme une fracture extrêmement comminutive se cache parfois derrière une simple ouverture de la peau. Les lésions dépassant le cadre strict du plan osseux peuvent intéresser à divers degrés toutes les structures : peau, fascia, muscles voire les éléments vasculonerveux ; et c'est elles qui feront alors le pronostic de la fracture ouverte. Il découle de ce préambule plusieurs préceptes.• La prise en charge de l'ensemble des structures lésées lors d'une fracture ouverte de jambe, que ce soit en aigu ou en secondaire, doit demeurer une préoccupation constante. Plusieurs situations cliniques vont d'ailleurs associer la peau et l'os dans le spectre lésionnel et la prise en charge thérapeu-tique : les fractures vues en urgence ou celles, redoutables, vues à 15 jours-3 semaines, les pseudarthroses infectées, l'infection chronique sur os consolidé, à part la nécrose sans fracture, qui expose un os sain et qui posera des problèmes spécifiques. • L'état cutané et le statut vasculaire priment pour obtenir une consolidation sans infection. D. L. Nen et al., Réparations tissulaires à la jambe

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“…As for those comminuted cases usually associated with high energy trauma, soft tissue status sometimes should be considered much more over the union rate. [4,5] have reported that fibular fixation is a must for comminuted tibia fracture patterns.…”

Section: To Perform a Well-matched Pair Comparison In Clinicalmentioning

confidence: 99%

“…In the research of Bonnevialle et al [5], 126 cases of distal tibial fractures associated with fibular fractures were enrolled. The fibula lesions were not treated in 79 cases and the other 47 cases were fixed.…”

Section: To Perform a Well-matched Pair Comparison In Clinicalmentioning

confidence: 99%

Reply to comment on Cheng et al.: Comparison study of two surgical options for distal tibia fracture—minimally invasive plate osteosynthesis vs. open reduction and internal fixation

Wang

2011

International Orthopaedics (SICOT)

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Dear Editor, We read the comments on our research article entitled "Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation" [1] in International Orthopaedics. Thank you for the constructive arguments from our colleagues.However, we could not totally agree with the conclusion, and discussions on several aspects below contribute to our viewpoints. However, Gupta et al. [4] argued clearly in their discussion that "It is not essential to fix fibular fractures in the presence of a simple fracture pattern of the tibia provided the fibular fracture is proximal to the syndesmosis. However, any fibular fracture at the level of or

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Distal leg fractures: How critical is the fibular fracture and its fixation?

Abstract: Level IV (prospective cohort study).

Cited by 33 publications

References 26 publications

Complications after surgical management of distal lower leg fractures

Complications after surgical management of distal lower leg fractures

Prise en charge initiale des fractures ouvertes de jambe

Reply to comment on Cheng et al.: Comparison study of two surgical options for distal tibia fracture—minimally invasive plate osteosynthesis vs. open reduction and internal fixation

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