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

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 fracturesapplied with intramedullary nailing is investigated.Methods: A retrospective examination was made of 67 patients aged 19-85 years who were applied withintramedullary nailing for a tibial shaft fracture (AO-42) between January 2010 and December 2016. The 44patients 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 respectof 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 Group2 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 ofmalalignment 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 ananatomic fibula compared to those with non-anatomic fibula. Although the anatomic fibula slows the rate ofunion, it prevents malalignment.

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