The Role of Fibular Fixation in the Treatment of Combined Distal Tibia and Fibula Fracture: A Randomized, Control Trial

Javdan, Mohammad; Tahririan, Mohammad Ali; Nouri, Morteza

doi:10.4103/2277-9175.205190

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…The inclusion processes and reasons for exclusion are depicted in Figure 1 . Three [ 22 , 24 , 25 ] studies were randomized controlled trials, another three [ 20 , 21 , 26 ] of the seven were retrospective studies, and only one [ 23 ] was a prospective cohort study. All patients, both in the trial and control groups, were treated with interlocking IM nail or plate fixation for tibia fracture, and patients in the trial group additionally underwent fixation with a 3.5 mm dynamic compression plate (DCP) for fibula fracture.…”

Section: Resultsmentioning

confidence: 99%

“…All patients, both in the trial and control groups, were treated with interlocking IM nail or plate fixation for tibia fracture, and patients in the trial group additionally underwent fixation with a 3.5 mm dynamic compression plate (DCP) for fibula fracture. Two studies [ 22 , 23 ] excluded patients with open fractures, leaving all patients included with closed fractures. All patients were followed up for more than 6 months (from 6 to 21 months) with valgus/varus and posterior/anterior angulations and nonunion, and the infection rates of most patients were assessed.…”

Section: Resultsmentioning

confidence: 99%

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The Role of Fibular Fixation in Distal Tibia-Fibula Fractures: A Meta-Analysis

Wang

et al. 2021

Advances in Orthopedics

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Objectives. The necessity of fibular fixation in distal tibia-fibula fractures remains controversial. This study aimed to assess its impact on radiographic outcomes as well as rates of nonunion and infection. Methods. A systematic search of the electronic databases of PubMed, Embase, and Cochrane library was performed to identify studies comparing the outcomes of reduction and internal fixation of the tibia with or without fibular fixation. Radiographic outcomes included malalignment and malrotation of the tibial shaft. Data regarding varus/valgus angulation, anterior/posterior angulation, internal/external rotation deformity, and the rates of nonunion and infection were extracted and then polled. A meta-analysis was performed using the random-effects model for heterogeneity. Results. Additional fibular fixation was statistically associated with a decreased rate of rotation deformity (OR = 0.13; 95% CI 0.02–0.82, p = 0.03 ). However, there was no difference in the rate of malreduction between the trial group and the control group (OR = 0.86; 95% CI 0.27–2.74, p = 0.80 ). There was also no difference in radiographic outcomes of varus-valgus deformity rate (OR = 0.17; 95% CI 0.03–1.00, p = 0.05 ) or anterior-posterior deformity rate (OR = 0.76; 95% CI 0.02–36.91, p = 0.89 ) between the two groups. Meanwhile, statistical analysis showed no significant difference in the nonunion rate (OR = 0.62; 95% CI 0.37–1.02, p = 0.06 ) or the infection rate (OR = 0.81; 95% CI 0.18–3.67, p = 0.78 ) between the two groups. Conclusions. Additional fibular fixation does not appear to reduce the rate of varus-valgus deformity, anterior-posterior deformity, or malreduction. Meanwhile, it does not appear to impair the union process or increase the odds of infection. However, additional fibular fixation was associated with decreased odds of rotation deformity compared to controls.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The Role of Fibular Fixation in Distal Tibia-Fibula Fractures: A Meta-Analysis

Wang

et al. 2021

Advances in Orthopedics

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“…However, some other studies found that standard open reduction and internal fixation of tibia with intramedullary nail or minimally invasive percutaneous plate osteosynthesis (MIPPO), without the fibula being fixed, had good reduction stability of tibial fracture, reduced the risk of soft tissue injury and infection, and had a good prognosis of function [ 7 – 9 ]. Javdan [ 10 ] reported that dynamic compression bone plate (DCP) or tubular plate fixation of fibula had no significant difference in influence on tibial fracture healing, reduction of postoperative complications and recovery of affected limb function. In addition, a few studies have shown that fibular plate internal fixation can increase the rate of delayed healing and non-healing of tibial fractures [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

Sun

Zhou

et al. 2021

BMC Musculoskelet Disord

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Background To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. Methods From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and Kirschner wire (group C, n = 26). The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. Results Four patients were lost to follow-up, and 87 patients were followed up for 5–35 months (average, 14.2 months). The operation time of group C (114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B (184.00 ± 48.56 min) (P < 0.05). There was no difference in intraoperative blood loss among the three groups (P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P < 0.05). The fracture healing time of group C (5.67 ± 1.42 months) was significantly less than that of group A (6.90 ± 1.33 months) and group B (6.70 ± 1.12 months) (P < 0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P < 0.05). The wound infection and needle-tract infection did not differ among the three groups (P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05). Conclusion Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.

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“…e work in [10] compared biomechanically bionic, helical, and endobutton thread fixation during tibiofibular syndesmosis treatment. In present, there is no clear consensus on the optimum management of combined distal third tibia and fibula fractures [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Mathematical Modelling of Destabilization Stress Factors of Stable-Elastic Fixation of Distal Trans- and Suprasyndesmotic Fibular Fractures

Chuzhak

Sulyma

Ropyak

et al. 2021

Journal of Healthcare Engineering

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Introduction. Specification of possible stress factors destabilizing the fibula stable osteosynthesis by the intramedullary nail with distal blocking and elastic fixation of distal syndesmosis by the thread with endobuttons by mathematical modelling of distal unstable ankle injuries. Material and Methods. We studied the thread tension during the combined stable-elastic fixation of unstable injuries of the ankle joint in cross-syndesmosis fractures of the fibula (B, C Danis–Weber classification), which includes a one-time stable minimally invasive fixation with the intramedullary nail and elastic fixation by the thread with endobuttons. We used a titanium alloy for the intramedullary nail and polyester for the thread. The deformed state was studied using the methods of mechanics. Results. A model of a fractured fibula blocked with the intramedullary nail and fixed with the elastic thread was developed. A formulation to specify the rational tension forces of the elastic thread depending on the parameters of the fibula and intramedullary blocking nail and on the location of the bone injury was obtained. The effect of foot rotation on the thread tension was investigated. The results of theoretical research should be implemented in medical practice. Conclusions. A mathematical model of the damaged fibula blocked by the intramedullary nail and fixed with the elastic thread was developed. Dependences for calculation of tension of the fixing thread were obtained. A slight increase in thread tension during foot rotation was found.

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The Role of Fibular Fixation in the Treatment of Combined Distal Tibia and Fibula Fracture: A Randomized, Control Trial

Cited by 14 publications

References 22 publications

The Role of Fibular Fixation in Distal Tibia-Fibula Fractures: A Meta-Analysis

The Role of Fibular Fixation in Distal Tibia-Fibula Fractures: A Meta-Analysis

External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

Mathematical Modelling of Destabilization Stress Factors of Stable-Elastic Fixation of Distal Trans- and Suprasyndesmotic Fibular Fractures

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