Due to the nature of the intervention it is not possible to blind participants or the immediate research team to the allocated intervention. Follow-up visit and radiographs were taken 2, 4 weeks, 3, 6 and 9 months after surgery. Malunion was defined as a varus–valgus angulation of more than 5° and an anterior-posterior angulation of more than 10°. Union was defined as when patients could tolerate unprotected weight bearing accompanied by radiographic criteria of union. Primary outcomes were varus-valgus angulation, ant/pos angulation, union and side effects, which were recorded for each group during the 9-month follow-up. We also allowed partial weight-bearing immediately after surgery and progressively after that depending on radiographic signs of union in the first 3 months. Range of motion of the ankle and knee was allowed immediately after operation. Patients had locking nail placed in tibia and were statically locked with distal locking bolt configuration two medial to lateral bolts or DCP or LCP plating.īetween first day and 13 th days from the time of the injury, surgery was performed by different surgeons. Reamed intramedullary nail or plate and screw was placed in tibia in all of the patients according to type and location of fracture. All procedures were performed under spinal or general anesthesia. Patients who received fixation of the tibia without fibular fixation were allocated in the control group. In the case group, fibula was fixed by a 3.5 mm DCP or one-third tubular plate through lateral approach prior to the fixation of tibia. Sixty eligible patients were randomly divided into two groups with 30 patients using random-maker software “Random Allocation”. Also, exclusion criteria included refractures, pathologic fractures, articular involvement, vascular and soft tissue injuries, multiple fractures and chronic systemic or infective disease with intraction by healing process such as DM. Patients older than 18 years old in both genders with combined distal tibia and fibular fractures AO/OTA 43 A1-3, who had fractures less than 2 weeks old, were eligible if they had no evidence of syndesmotic injury or open fractures. The ethics committee of Isfahan University of Medical Sciences approved this study, and written informed consent was obtained from all studied patients. This randomized, parallel-group, non-blind study was conducted between Sep, 2013, and May, 2014, on 60 patients with distal tibial and fibular fractures who were referred to Al-Zahra and Kashani hospitals in Isfahan, Iran. We hypothesized that fixation of the fibula increases the stability of fixation in distal tibial and fibular fractures without increasing other complications, such as nonunion or delayed union. So, the present study was aimed to determine the role of fibular fixation in combined distal tibia and fibula fractures. There seems to be a controversy about fibular fixation in the treatment of distal tibial fractures and data about the impact of fibular fixation in distal tibia-fibula fractures are limited. On the other hand, fibular fixation may result in delayed union or nonunion because it inhibits the cyclic loading on the tibial fracture site. Previously, studies have reported that effective plating of the fibula fracture improves alignment and the ability of the tibial fracture fixation to resist motion across the defect and prevents loss of reduction. In both clinical and laboratory settings the role of fibular fracture fixation in cases of distal tibia-fibula fractures has been examined, and particularly in the setting of distal tibia fractures, has been shown to help maintaining the tibia fracture reduction. Fibula fixation as an adjunct method was proposed by Morrison et al., to manage the fractures of the tibia and fibula. Although different treatment methods have been developed for distal tibia fractures and external fixation, plate and intramedullary nailing are the surgical options for tibial fractures, there is currently no consensus on the optimal mode of management.įibular fractures in 77.7% of the cases are common with tibial fractures. Management of distal injuries is often different and more complex. Treatments of distal tibial fractures are frequently associated with worse results and complications, leading to the poor outcome measurements in tibia diaphyseal fractures. Delayed union and nonunion could be complications of tibial fractures. Distal tibial fractures account for 37.8% of all tibial fractures, and the fractures of the distal tibia typically occur as a result of axial and rotational forces on the lower extremity and represent approximately 10% of fractures of the distal end of the tibia. Multiple factors such as systemic and soft-tissue injury, device stability and host factors like diabetes, immunodeficiency, and nicotine abuse affect tibial fracture healing.
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