Role of fibular fixation in static intramedullary interlocking nailing for distal third tibia and fibula fracture

Abstract

Treatment of distal third tibia and fibula fractures remains a challenge classically being treated with standard plating, but intramedullary nailing has gained popularity. As there is a mismatch between the diameters of the nail and the medullary canal, with no nail-cortex contact, the nail may translate laterally along coronally placed locking screws and increased stress in placed on the locking holes to maintain fracture alignment after surgery. Various techniques have been recommended to improve nailing in these fractures including fibular plating (distal third fractures), temporary unicortical plating, different nail design with different proximal bends (proximal third fractures) and blocking screws (poller screws). The aim of the study is to evaluate the clinical use of fibular plating as a supplement to stability in addition to intramedullary nailing in distal both bone fractures of leg. Methods: A prospective study of 20 cases of distal third tibia fibula fractures treated with statically locked intra medullary nailing with supplementary fibular plating between March 2017 and September 2018 at RIMS, Ranchi. All the fractures were followed through till union of fracture with clinical and radiological examination at intervals of 4 to 6 weeks. On follow up axial alignment was assessed and functional analysis was quantified using Karlstorm -Olerud score. Complications were divided into those which were related to fibular plate and those which were not. Results: All the fractures eventually united in a mean period of 12.8 weeks. Karlstrom-Olerud score was excellent in 12 fractures (60%), good in 5 patients (25%) and fair in 2 patients (10%) and poor in 1 patient (5%).The alignment was maintained in coronal plane till union with the mean remaining the same i.e 1.6 degrees. The mean sagital plane alignment at the time of union was 0.4 degrees, the loss of alignment was not statistically significant. The fibular plate related complications were encountered in two cases where we had skin necrosis and deep infection, which needed aggressive antibiotic therapy and those patients were also given cast support for twelve weeks. Conclusion: Fibular plating, when supplemented the intramedullary nailing of distal third tibia fibula fractures, were effective in achieving the fracture alignment especially in fresh fractures, Improves not only angular stability but also rotational stability, Maintained the fracture alignment till union and prevents loss of initial reduction.