Effect of anatomic fibula on tibia union and alignment after intramedullary nailing of tibia shaft fractures

Year 2020, Volume: 6 Issue: 4, 337 - 342, 04.07.2020

Ali Teoman Evren , Yüksel Uğur Yaradılmış , Mustafa Caner Okkaoğlu Ahmet Ateş İsmail Demirkale , Murat Altay

https://doi.org/10.18621/eurj.497382

Cited By: 1

Abstract

Objectives: The effect of an intact or fixated fibula on tibial union and alignment in tibial shaft fractures applied with intramedullary nailing is investigated.

Methods: A retrospective examination was made of 67 patients aged 19-85 years who were applied with intramedullary nailing for a tibial shaft fracture (AO-42) between January 2010 and December 2016. The 44 patients included in the study were separated into 2 groups as those with anatomic fibula (Group 1, n = 12) and those with a fibula fracture which is not fixated (Group 2, n = 32). The patients were evaluated in respect of bone union and malalignment from direct radiographs. Union was evaluated according to the RUST criteria, and the threshold for malalignment was taken as 5˚ in the coronal and sagittal planes.

Results: The patients comprised 24 males and 20 females (M/F: 6/5) with a mean age of 42.7 years (range, 19-76 years). Non-union was observed in 3/12 patients (25%) in Group 1, and in 2/32 (6.3%) patients in Group 2 at 6 months. Malalignment was observed in 1/12 (8.3%) patients in Group 1 (procurvatum) and in 7/32 (21.8%) patients in Group 2, of which 3 (9.3%) were varus, and 4 (12.5%) were valgus. The rate of malalignment was significantly lower in Group 1 than in Group 2.

Conclusions: The results demonstrated that bone union of a tibial shaft fracture is slower in patients with an anatomic fibula compared to those with non-anatomic fibula. Although the anatomic fibula slows the rate of union, it prevents malalignment.

Keywords

Tibia shaft fracture, intramedullary nailing, intact fibula, malunion, non-union

References

• 1. Kojima K, Ferreira R. Tibial shaft fracture. Rev Bras Ortop 2011;46:130-5.
• 2. Court-Brown CM, McBirnie J. The epidemiology of tibial fractures.J Bone Joint Surg Br 1995;77:417-21.
• 3. Sarmiento A, Latta LL. 450 closed fractures of the distal third of the tibia treated with a functional brace. Clin Orthop Relat Res 2004;428:261-71.
• 4. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br 2010;92:984-8.
• 5. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 2011;25:736-41.
• 6. Court-Brown CM, Christie J, McQueen MM. Closed intramedullary tibial nailing. Its use in closed and type I open fractures. J Bone Joint Surg Br 1990;72:605-11.
• 7. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M; Evidence-Based Orthopaedic Trauma Working Group. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma 2006;20:76-9.
• 8. Teitz C, Carter Di Frankel V. Problems associated with tibial fractures with intact fibulae. J Bone Joint Surg 1980;62:770-6.
• 9. Leow JM, Clement ND, Tawonsawatruk T, Simpson CJ, Simpson AHRW. The radiographic union scale in tibial (RUST) fractures. Bone Joint Res 2016;5:116-21.
• 10. Alho A, Ekeland A, Strømsøe K, Follerås G, Thoresen BO. Locked intramedullary nailing for displaced tibial shaft fractures. J Bone Joint Surg Br 1990;72:805-9.
• 11. Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta P 3rd, Hanson B, Weaver B, et al. Surgeons’ preferences for the operative treatment of fractures of the tibial shaft. An international survey. J Bone Joint Surg Am 2001;83-A:1746-52.
• 12. Russell TA. Fractures of the tibia and fibula. In: Rockwood CA, Green DP, Buckolz RW, Heckman JD, editors. Fractures in adults. 4th ed. Philadelphia: Lippincott; 1996: pp. 2139-57.
• 13. Jorgensen TE. The influence of the intact fibula on the compression of a tibial fracture or pseudoarthrosis.Acta Orthop Scand 1974;45:119-29.
• 14. Bone LB, Sucato D, Stegemann PM, Rohrbacher BJ. Displaced isolated fractures of the tibial shaft treated with either a cast or intramedullary nailing. An outcome analysis of matched pairs of patients. J Bone Joint Surg Am 1997;79:1336-41.
• 15. Balaji SM, Chandra PM, Devadoss S, Devadoss A. The effect of intact fibula on functional outcome of reamed intramedullary interlocking nail in open and closed isolated tibial shaft fractures: a prospective study. Indian J Orthop 2016;50:201-5.
• 16. Whelan DB, Bhandari M, McKee MD, Guyatt GH, Kreder HJ, Stephen D, et al. Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation. J Bone Joint Surg Br 2002;84:15-8.
• 17. Court-Brown CM. Reamed intramedullary tibial nailing: an overview and analysis of 1106 cases. J Orthop Trauma 2004;18:96-101.
• 18. De Giacomo A, Tornetta P. Alignment after intramedullary nailing of distal tibia fractures without fibula fixation. J Orthop Trauma 2016;30:561-7.