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Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures?
J Orthop Trauma. 2006 Feb; 20(2):94-103.JO

Abstract

OBJECTIVE

Evaluate whether supplementary fibular fixation helped maintain axial alignment in distal metaphyseal tibia-fibula fractures treated by locked intramedullary nailing.

DESIGN

Retrospective chart and radiographic review.

SETTING

Three, level 1, trauma centers.

PATIENTS

Distal metaphyseal tibia-fibula fractures were separated into 2 groups based on the presence of adjunctive fibular plating. Group 1 consisted of fractures treated with small fragment plate fixation of the fibula and intramedullary (IM) nailing of the tibia, whereas group 2 consisted of fractures treated with IM nailing of the tibia without fibular fixation.

OUTCOME MEASURES

Malalignment of the tibial shaft was defined as 1) >5 degrees of varus/valgus angulation, or 2) >10 degrees anterior/posterior angulation. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 6-month follow-up. Leg length and rotational deformity were not examined.

RESULTS

Seventy-two fractures were studied. In 25 cases, the associated fibula fracture was stabilized, and in 47 cases the associated fibula fracture was not stabilized. Cases were more likely to have the associated fibula fracture stabilized where the tibia fracture was very distal. In multivariate adjusted analysis, plating of the fibula fracture was significantly associated with maintenance of reduction 12 weeks or later after surgery (odds ratio = 0.03; P = 0.036). The use of 2 medial-lateral distal locking bolts also was protective against loss of reduction; however, this association was not statistically significant (odds ratio = 0.29; P = 0.275).

CONCLUSIONS

In this study, the proportion of fractures that lost alignment was smaller among those receiving stabilization of the fibula in conjunction with IM nailing compared with those receiving IM nailing alone. Adjunctive fibular stabilization was associated significantly with the ability to maintain fracture reduction beyond 12 weeks. At the present time, the authors recommend fibular plating whenever IM nailing is contemplated in the unstable distal tibia-fibular fracture.

Authors+Show Affiliations

Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, New York, NY 10003, USA. kenneth.egol@nyumc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16462561

Citation

Egol, Kenneth A., et al. "Does Fibular Plating Improve Alignment After Intramedullary Nailing of Distal Metaphyseal Tibia Fractures?" Journal of Orthopaedic Trauma, vol. 20, no. 2, 2006, pp. 94-103.
Egol KA, Weisz R, Hiebert R, et al. Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures? J Orthop Trauma. 2006;20(2):94-103.
Egol, K. A., Weisz, R., Hiebert, R., Tejwani, N. C., Koval, K. J., & Sanders, R. W. (2006). Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures? Journal of Orthopaedic Trauma, 20(2), 94-103.
Egol KA, et al. Does Fibular Plating Improve Alignment After Intramedullary Nailing of Distal Metaphyseal Tibia Fractures. J Orthop Trauma. 2006;20(2):94-103. PubMed PMID: 16462561.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures? AU - Egol,Kenneth A, AU - Weisz,Russell, AU - Hiebert,Rudi, AU - Tejwani,Nirmal C, AU - Koval,Kenneth J, AU - Sanders,Roy W, PY - 2006/2/8/pubmed PY - 2006/6/2/medline PY - 2006/2/8/entrez SP - 94 EP - 103 JF - Journal of orthopaedic trauma JO - J Orthop Trauma VL - 20 IS - 2 N2 - OBJECTIVE: Evaluate whether supplementary fibular fixation helped maintain axial alignment in distal metaphyseal tibia-fibula fractures treated by locked intramedullary nailing. DESIGN: Retrospective chart and radiographic review. SETTING: Three, level 1, trauma centers. PATIENTS: Distal metaphyseal tibia-fibula fractures were separated into 2 groups based on the presence of adjunctive fibular plating. Group 1 consisted of fractures treated with small fragment plate fixation of the fibula and intramedullary (IM) nailing of the tibia, whereas group 2 consisted of fractures treated with IM nailing of the tibia without fibular fixation. OUTCOME MEASURES: Malalignment of the tibial shaft was defined as 1) >5 degrees of varus/valgus angulation, or 2) >10 degrees anterior/posterior angulation. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 6-month follow-up. Leg length and rotational deformity were not examined. RESULTS: Seventy-two fractures were studied. In 25 cases, the associated fibula fracture was stabilized, and in 47 cases the associated fibula fracture was not stabilized. Cases were more likely to have the associated fibula fracture stabilized where the tibia fracture was very distal. In multivariate adjusted analysis, plating of the fibula fracture was significantly associated with maintenance of reduction 12 weeks or later after surgery (odds ratio = 0.03; P = 0.036). The use of 2 medial-lateral distal locking bolts also was protective against loss of reduction; however, this association was not statistically significant (odds ratio = 0.29; P = 0.275). CONCLUSIONS: In this study, the proportion of fractures that lost alignment was smaller among those receiving stabilization of the fibula in conjunction with IM nailing compared with those receiving IM nailing alone. Adjunctive fibular stabilization was associated significantly with the ability to maintain fracture reduction beyond 12 weeks. At the present time, the authors recommend fibular plating whenever IM nailing is contemplated in the unstable distal tibia-fibular fracture. SN - 0890-5339 UR - https://www.unboundmedicine.com/medline/citation/16462561/Does_fibular_plating_improve_alignment_after_intramedullary_nailing_of_distal_metaphyseal_tibia_fractures L2 - http://dx.doi.org/10.1097/01.bot.0000199118.61229.70 DB - PRIME DP - Unbound Medicine ER -