DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20194627

Can isolated tibia intramedullary interlocking nailing in fracture distal 1/3rd both bone leg prevent fracture malalignment: will concurrent fibula fixation help?

Vignesh Veluswamy, Senthil Loganathan, Thiyagarajan Uma Shankar, Pradeep Jayaram Purushothaman, Gokul Raj Dhanarajan

Abstract


Background: Different stand point prevails till date concerning fibular osteosynthesis in distal third both bone fracture fixation. This study was done to assess the post op alignment of distal third both bones fracture without fixing Fibula.

Methods: A total of 30 patients who had distal 1/3rd extra articular tibia and fibula fractures were included in the study from July 2016 to April 2019. Tibial nailing was done in all cases with care is taken particularly to prevent malalingment of distal fragment. Radiological malalignment were assessed post operatively.

Results: Of 30 patients, 5 patients had excellent results and 21 patients had good results, only 4 patients had fair results with valgus and varus malalignment, however these patients did not have any clinical problems associated with these malalignment at one year follow up. No patients had poor results. Valgus tibial malalignment is observed more frequently when fibular fracture is at proximal level.

Conclusions: The level of Fibular fracture is important to determine when the fixation of this bone is indicated. Fixing ipsilateral tibial fracture with intramedullary interlocking (IMIL) nailing without fibular synthesis produce no gross change in alignment provided adequate care is taken for intra operative centering of the nail in both AP and lateral views.


Keywords


Distal 1/3rd both bone leg fracture, Tibia IMIL, Radiological alignment

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References


Rockwood Jr CA, Green OP, Bucholz RW, Heckman JD. Fractures of the Tibia and Fibula. In: Rockwood CA, Green DP, editors. 4th ed., Rockwood and greens fractures in adults, vol. 2, 4th ed. Philadelphia: Lippincott-Raven; 1996.

Gerard Y, Evrard J. Fractures extra-articulaires du quart inférieur de la jambe. J Chir (Paris). 1963;85:61-70.

Zucman J, Roux JP. Fractures basses récentes de jambe chezl’adulte. Définition, classification, résultats thérapeutiques à propos de 109 cas. Rev Chir Orthop Reparatrice Appar Mot. 1972;58:789-802.

Utheza G, Chandeclerc D, Cuzacq JP. Les fractures extraarticulairesde l’extrémité inférieure du Tibia. Rev Med Toulouse. 1972;8:93-9.

Sarmiento A, Latta LL. 450 closed fractures of the distal third of the tibia treated with a functional brace. Clin Orthop Relat Res. 2004;426:261-71.

Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: plating versus shortened intramedullary nailing. Injury. 2006;37:531-5.

Mosheiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury. 1999;30:83-90.

Dogra AS, Ruiz AL, Thompson NS, Nolan PC. Diametaphyseal distal tibial fractures - treatment with a shortened intramedullary nail. A review of 15 cases. Injury. 2000;31:799-804.

Janssen KW, Biert J, Van Kampen A. Treatment of distal tibial fractures: plate versus nail. A retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31:709-14.

Labronici PJ, Franco JS, Fernandes Da Silva A, Martins De Pina Cabral F, et al. Treatment of distal fractures of the tibia. Acta Orthop Bras. 2009;17:40-5.

Borg T, Larson S, Lindsjo U. Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients. Injury. 2004;35:608-14.

Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007;21:355-61.

Ronga M, Shanmugam C, Longo UG, Maffulli N. Minimally invasive osteosynthesis of distal tibia fractures using locking plates is safe and effective. Orthop Clin North Am. 2009;40:499-504.

Gao H, Zhang CQ, Luo CF, Zhou ZB, Zeng BF. Fractures of the distal tibia treated with polyaxial locking plate. Clin Orthop Relat Res. 2009;467:831-7.

Varsalona R, Liu GT. Distal Tibial metaphyseal fractures:the role of Fibular fixation. Strat Traum Limb Recon. 2006;1:42-50.

Strauss EJ, Alfonso D, Kummer FJ, Egol KA, Tejwani NC. The effect of concurrent Fibular fracture on the fixation ofdistal Tibia fractures: a laboratory comparison of intramedullary nails with locked plates. J Orthop Trauma. 2007 ;21:172-7.

Bonnevialle P, Lafosse JM, Pidhorz L, Poichotte A, Asencio G, Dujardin F. Distal leg fractures: how critical is the fibular fractures and its fixation? OrthopTraumatol Surg Res. 2010;96:667-73.

Jeffrey R, Kevin C, Oliver B, Peter K, David H. Nonunions of the distal tibia treated by reamed intramedullary nailing. J Orthop Trauma. 2004;18:603-10.

Schoot DKE, Outer AJD, Bode PJ, Obsermann WR, Vugt AB. Degenerative changes at the knee and ankle related to mal-union of tibial factures-15 year follow up of 88 patients. J Bone Joint Surg Br. 1996;78:722-5.

McKellop HA, Llinas A, Sarmiento A. Effects of tibial malalignment on the knee and ankle. Orthop Clin North Am. 1994;25:415-23.

Puno RM, Vaughan JJ, Fraunhofer JA, Stetten ML, Johnson JR. A method of determining the angular malalignments of the knee and ankle joints resulting from a tibial mal-union. Clin Orthop. 1987;223:213-9.

Prasad M, Yadav S, Sud A, Arora N, Kumar N, Singh S. Assessment of the role of fibular fixation in distal-third tibia-fibula fractures and its significance in decreasing malrotation and malalignment. Injury, Int J Care Injured. 2014;44:1885-91.

Teitz CC, Carter DR, Frankel VH, Washington S. Problems associated with Tibial fractures with intact Fibula. J Bone Joint Surg Am. 1980;62:770-6.

Weber TG, Harrington RM, Henley MB, Tencer AF. The role of Fibular fixation in combined fractures of the Tibia and Fibula: a biomechanical investigation. J Orthop Trauma. 1997;11(3): 206-11.

Nork SE. Distal tibia fractures. In: Stannard JP, Schmidt AH, Kregor PJ, eds. Surgical Treatment of Orthopaedic Trauma. New York, NY: Thieme; 2007: 767-791.

Vukicevic S, Stern-Padovan R, Vukicević D, Keros P. Holographic investigations of the human tibiofibular interosseous membrane. Clin Orthop Relat Res. 1980;151:210-4.

Skraba J, Greenwald SA. The role of the interosseous membrane on tibiofibular weightbearing. Foot Ankle. 1984;4(6):301-4.

Konig M, Gotzen L. Pseudarthroses of the fibula following fractures of the lower leg. Unfallchirurg. 1989;92(4):191-4.

Gotzen L, Haas N, Hutter J, Koller W. The importance of the fibula for stability in plate osteosynthesis of the tibia (author’s transl). Unfallheilkunde 1978;81(5):409-16.

Ruedi T. Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation. Injury. 1973;5(2):130-4.

Ruedi T, Matter P, Allgower M. Intra-articular fractures of the distal tibial end. Helv Chir Acta. 1968;35(5):556-82.

Pogliacomi F. When is indicated Fibular fixation in extra-articular fractures of the distal Tibia? Acta Biomed. 2018;89(4):558-63.

Merchant TC, Dietz FR. Long term follow up after fractures of the tibial and fibular shafts. J Bone Joint Surg Am. 1989;71:599-606.

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.