الفهرس 
Anatomy
Mechanisms of InjuryOnly 14 pages are availabe for public view
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Abstract
Summary
The aim of this study was to evaluate the effect of fibular fixation on distal
tibial fractures treated by locked intramedullary nail.
This study included twenty-five patients with recent distal one third tibial
fractures above the age of 18 years that were admitted to emergency hospital from the
August 2013 to august 2015.Twenty of them have attended the final follow-up period
which was at least 6 months from the date of initial injury.
All patients were males except two females. Etiology of fracture was motor
vehicle in fourteen cases and direct fall on the leg in six cases which have no effect on
union or functional results.
The fracture line was transverse in six patients, oblique in seven patients, and
short oblique in five patients and comminuted in seven patients and twenty two
patients were closed while the remaining three were open (gustilo grade I,II) and
these factors have no effect on functional result.
Only three patients (12%) had associated injuries, two had ipsilateral fracture
humerus and the one had ipsilateral fracture femur.
After subjecting patients to both clinical and radiological examination on
admission to the hospital, thirteen patients were treated using interlocking
intramedullary nails only and other twelve treated with interlocking intramedullary
nails with fibular plating and the methods of treatment were chosen randomly.
There were 17 patients with excellent results, seven patients with good results and
one patient with a poor result.
At the end of follow up and according to the method of clinical evaluation, 24
patients were satisfied (excellent in 17 patients and good in 7 patients) and only one
patient wasn’t satisfied.
Fifteen fractures (60%) healed within 12 weeks, and six fractures (24%)
healed in 14 weeks, two fractures healed in 16 weeks. One tibial fracture (4%) didn’t
unit after 24 weeks and was considered as un-united fracture and required a secondry
procedure. All fibular fractures fixed with plate had time to union range from 5 to 8
weeks on average 6.5 weeks.Conclusion
In the present study fibular fixation didn’t affect the end result and the only nonunited
tibia happened in the group with fibular fixation.
Evaluation of alignment in group with fibular plating showed no cases of
malalignment of the tibia in the frontal plane and two (10%) cases of anterior tibial
angulation within 5 degree. There were no cases of leg length discrepancy or
rotational malalignment.
Intramedullary nailing is an effective method in the treatment of distal tibial
fracture. The benefit is the minimally invasive technique, offer smaller incisions,
minimal surgical trauma to the fracture zone, allow more rapid rehabilitation and are
associated with relatively minor complications and also provides the advantage of
short hospitalization.
In conclusion Fibular fixation has no significance on functional results in both
groups in this study. The debate whether it maintains alignment, controls rotation and
adds stability, or does it maintains the tibial gap and reduces the strain at the fracture
side combating union; this debate seems to be still equivocal.
So if there is any patient with distal tibial & fibular fracture it is better to fix tibia
without fibula to prevent increasing time of operation by O.R.I.F of fibula and to
decrease the cost of operation as no role for fibular fixation in distal tibial fracture.