When is indicated fibular fixation in extra-articular fractures of the distal tibia?
Journal
Acta bio-medica : Atenei Parmensis
ISSN: 2531-6745
Titre abrégé: Acta Biomed
Pays: Italy
ID NLM: 101295064
Informations de publication
Date de publication:
15 01 2019
15 01 2019
Historique:
received:
26
10
2018
accepted:
29
10
2018
entrez:
19
1
2019
pubmed:
19
1
2019
medline:
6
2
2020
Statut:
epublish
Résumé
There is no consensus about indications for fibular osteosynthesis in extra-articular fractures of the distal tibia (DTF). This study analyses patients affected by DTF associated to fibular fracture and has the aim to define whether the level of fibular fracture has an influence on bone healing and consequently when its fixation is indicated. Eighty-seven patients were operated from January 2005 to December 2016. Inclusion criteria were: the presence of skeletal maturity, the absence of physical limitations before trauma and a type 43-A AO closed fracture. Clinical outcomes were evaluated using Olerud-Molander Ankle Score (OMAS) and the Disability Rating Index (DRI). Malrotation was also assessed as well as incidence of nonunion and malalignment through x-rays. No differences in clinical scores were reported at follow-up between patients in which fibular fixation was performed (Group 1) in comparison with those in which this procedure was not executed (Group 2). Nonunions were registered in 8 cases: four in Group 1 and four in Group 2. A statistically significant difference in incidence of external malrotation and valgus malalignment between the groups was documented, with a higher risk in patients of the second group. The level of fibular fracture is important to determine when the fixation of this bone is indicated. In supra-syndesmotic fractures osteosynthesis leads to a higher incidence of nonunions. Fibular osteosynthesis could prevent malrotation and malalignment and is advisable in distal metaphyseal fracture of this bone (trans- or infrasyndesmotic lesion) with syndesmotic injury.
Sections du résumé
BACKGROUND AND AIM OF THE WORK
There is no consensus about indications for fibular osteosynthesis in extra-articular fractures of the distal tibia (DTF). This study analyses patients affected by DTF associated to fibular fracture and has the aim to define whether the level of fibular fracture has an influence on bone healing and consequently when its fixation is indicated.
METHODS
Eighty-seven patients were operated from January 2005 to December 2016. Inclusion criteria were: the presence of skeletal maturity, the absence of physical limitations before trauma and a type 43-A AO closed fracture. Clinical outcomes were evaluated using Olerud-Molander Ankle Score (OMAS) and the Disability Rating Index (DRI). Malrotation was also assessed as well as incidence of nonunion and malalignment through x-rays.
RESULTS
No differences in clinical scores were reported at follow-up between patients in which fibular fixation was performed (Group 1) in comparison with those in which this procedure was not executed (Group 2). Nonunions were registered in 8 cases: four in Group 1 and four in Group 2. A statistically significant difference in incidence of external malrotation and valgus malalignment between the groups was documented, with a higher risk in patients of the second group.
CONCLUSIONS
The level of fibular fracture is important to determine when the fixation of this bone is indicated. In supra-syndesmotic fractures osteosynthesis leads to a higher incidence of nonunions. Fibular osteosynthesis could prevent malrotation and malalignment and is advisable in distal metaphyseal fracture of this bone (trans- or infrasyndesmotic lesion) with syndesmotic injury.
Identifiants
pubmed: 30657124
doi: 10.23750/abm.v89i4.7775
pmc: PMC6502107
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
558-563Références
Clin Orthop Relat Res. 1976 Jul-Aug;(118):76-81
pubmed: 954295
Clin Orthop Relat Res. 1980 Sep;(151):210-4
pubmed: 7418307
Injury. 2013 Dec;44(12):1885-91
pubmed: 24074830
J Am Acad Orthop Surg. 2006 Jul;14(7):406-16
pubmed: 16822888
Injury. 1973 Nov;5(2):130-4
pubmed: 4774764
J Bone Joint Surg Am. 1986 Apr;68(4):543-51
pubmed: 3957978
J Bone Joint Surg Am. 1980 Jul;62(5):770-6
pubmed: 7391100
Clin Orthop Relat Res. 1984 Apr;(184):289-92
pubmed: 6705357
Clin Orthop Relat Res. 1992 Jun;(279):223-8
pubmed: 1600659
Unfallheilkunde. 1978 May;81(5):409-16
pubmed: 653888
J Orthop Trauma. 2006 Feb;20(2):94-103
pubmed: 16462561
Clin Orthop Relat Res. 1987 Oct;(223):213-9
pubmed: 3652579
Int Orthop. 2019 Jan;43(1):201-207
pubmed: 30135986
Arch Orthop Trauma Surg. 2012 Jul;132(7):975-84
pubmed: 22431141
J Orthop Trauma. 1998 Jan;12(1):16-20
pubmed: 9447514
Can J Surg. 2008 Feb;51(1):45-50
pubmed: 18248705
J Orthop Trauma. 1997 Apr;11(3):206-11
pubmed: 9181505
J Bone Joint Surg Am. 1956 Jul;38-A(4):761-81
pubmed: 13331972
J Bone Joint Surg Am. 2003 Apr;85(4):604-8
pubmed: 12672833
Injury. 2012 Jun;43(6):838-42
pubmed: 22036451
Injury. 2012 Jun;43(6):766-71
pubmed: 21962296
Clin Orthop Relat Res. 1991 May;(266):209-13
pubmed: 2019053
J Bone Joint Surg Am. 1971 Apr;53(3):507-13
pubmed: 5580009
J Bone Joint Surg Br. 1990 Jan;72(1):129-31
pubmed: 2298771
J Orthop Trauma. 2007 Jul;21(6):355-61
pubmed: 17620992
Orthop Traumatol Surg Res. 2010 Oct;96(6):667-73
pubmed: 20851076
J Orthop Trauma. 2006 Jan;20(1):76-9
pubmed: 16424818
J Orthop Trauma. 2015 Sep;29(9):e309-15
pubmed: 25756912
J Orthop Trauma. 2007 Mar;21(3):172-7
pubmed: 17473753
Orthop Traumatol Surg Res. 2010 Oct;96(6):674-82
pubmed: 20739249
J Trauma. 1983 Jul;23(7):591-6
pubmed: 6876212
J Bone Joint Surg Am. 2005 Jun;87(6):1213-21
pubmed: 15930529
Clin Orthop Relat Res. 1988 Sep;(234):159-69
pubmed: 3409571
Foot Ankle. 1984 May-Jun;4(6):301-4
pubmed: 6735287
J Orthop Trauma. 2011 Dec;25(12):736-41
pubmed: 21904230
Foot Ankle Surg. 2013 Sep;19(3):143-7
pubmed: 23830160
Unfallchirurg. 1989 Apr;92(4):191-4
pubmed: 2727714