Does Fibular Plating Improve Alignment After Intramedullary Nailing of Distal Metaphyseal Tibia Fractures?

Abstract

In this study, the proportion of fractures that lost alignment was smaller among those receiving stabilization of the fibula in conjunction with IM nailing compared with those receiving IM nailing alone. Adjunctive fibular stabilization was associated significantly with the ability to maintain fracture reduction beyond 12 weeks. At the present time, the authors recommend fibular plating whenever IM nailing is contemplated in the unstable distal tibia-fibular fracture.

Unreamed intramedullary nailing in distal tibial fractures

“…Although the case for this technique has been strengthened by the introduction of locking screws to maintain fracture length, alignment and rotation, there are concerns about nail use in distal segment fractures because of several technical limitations that make fracture reduction and stable fixation difficult [2,[22][23][24]. The long-lever arm, the short segment left for distal locking and the relatively wide metaphysis that can not afford a snug endosteal fit with little nail-cortex contact prohibiting automatic fracture alignment and allowing considerable nail mobility, all can result in a higher rate of malalignment and increased stress on the locking screws with a greater risk of screw failure, nail migration or ankle penetration [2,23]. This is further complicated by intra-articular extension or ankle instability due to lateral malleolar fractures [22][23][24].…”

“…The long-lever arm, the short segment left for distal locking and the relatively wide metaphysis that can not afford a snug endosteal fit with little nail-cortex contact prohibiting automatic fracture alignment and allowing considerable nail mobility, all can result in a higher rate of malalignment and increased stress on the locking screws with a greater risk of screw failure, nail migration or ankle penetration [2,23]. This is further complicated by intra-articular extension or ankle instability due to lateral malleolar fractures [22][23][24]. Such mechanical conditions are less favourable in unreamed nailing where the discrepancy between the nail diameter and the distal medulla is even greater.…”

Mathematical approximation of fibular malleolus curvature

“…5 In cases where both the distal tibia and fibula are fractured, except the tibial fixation by an external fixation device or intramedullary osteosynthesis, a growing number of authors supports the osteosynthesis of the fibula with a plate which facilitates reconstruction of the lateral column providing additional support to the ankle joint. 25,26 The curvature of the bone to which a plate is being placed to, is a key factor determining the contact surface and the amount of stress the plate applies to the bone. 22 In this study, using a mathematical modeling process we evaluated the surface topography of the fibula.…”

Role of the fibula in lower leg fractures: An in vivo investigation in rats

“…Clinical studies came to miscellaneous results, 8,11,12,24,25 but there is a tendency that fixation of the fibula could be helpful when less rigid fixation of the tibia fracture is used. However, the fracture's nature and the soft tissue situation have to be considered, when an additional incision is performed to fix the fibula.…”

“…There was no significant decrease in tibial defect site motion, when a plate or a distally and proximally locked intramedullary nail was used. In a retrospective study of 72 fractures, Egol et al 8 found that fibular plating improves alignment after statically locked intramedullary nailing of distal metaphyseal tibia fractures. Morrison et al 9 showed that fibular plate fixation increased both torsional and longitudinal stability of middiaphyseal tibial fractures treated with external fixation.…”