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The clinical outcome of combined distal third tibial and fibular fracture treatment with or without fibular fixation: A retrospective study

Background and Objectives: Distal tibial and concomitant fibular fracture is a common fracture. Fibular fixation in conjugation with tibial fixation with a locking plate is controversial. This study aimed to determine the effect of fibular fixation in distal tibial fracture fixed with a distal medial locking plate. Methods: This retrospective study was conducted on 33 patients with mixed distal tibial and fibular fractures referred to the trauma centers of Golestan and Aria hospitals in Ahvaz, Iran, and underwent surgery between September 2018 and January 2019. The patients were categorized into Group I with fibular fixation (n = 17) and Group II without fibular fixation (n = 16). Then, they were divided into two subgroups according to the level of fibular fracture. For the subgroup (a), fracture was at 7.5 cm distal fibular (n = 11) and for the subgroup (b), proximal to group “a” at distal third (n = 6). Data were collected by asking patients about their function and pain in daily activities and performing examination and radiographs 6 months postoperatively. The assessment of the ankle was performed using the AOFAS. Data were analyzed using Chi-square and t-test by the SPSS version 26. Results: Six months post operation, there were no cases of malunion or wound complication in both groups. There was an osteomyelitis case in Group II, but none in Group I. There were six nonunions in total: two in Group I and four in Group II (P = 0.325). Furthermore, AOFAS was significantly greater in Group I compared to Group II (76.18 ± 17.45 vs. 50.62 ± 18.88, P < 0.001). Conclusions: According to the findings of the present study, there is a positive and crucial relationship between fibular fixation and AOFAS in ankles with the combined distal third tibial and fibular fracture. There are no crucial differences in nonunion of tibia, malunion, wound complication, deep infection, and osteomyelitis between nonfixation and fibular fixation.