Ali Teoman EVREN, Yüksel Uğur YARADILMIŞ, Mustafa Caner OKKAOĞLU, Ahmet ATEŞ, İsmail DEMİRKALE, Cetin Murat ALTAY

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

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,

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