Randomized prospective study on the treatment of extra-articular fractures of the distal tibia with intramedullary locked nails with or without simultaneous fibula fixation.

Abstract

Extra-articular distal tibial fractures treated with locked intramedullary nails present a high rate of malunion, particularly rotational deformities. Concomitant fibular fixation has been associated with a reduction in malalignment; however, some studies suggest it may increase nonunion and complication rates, including infection. There is currently no consensus regarding the influence of fibular stabilization in these fractures. To compare radiographic outcomes, functional results, and complication rates of extra-articular distal tibial fractures treated with locked intramedullary nails, with or without concomitant fibular fixation. A randomized prospective study was conducted including patients aged 18-60 years with displaced extra-articular distal tibial fractures, including open fractures up to Gustilo type IIIA, associated with fibular fractures located below the middle third. Patients lost to follow-up or who did not complete all radiographic or functional assessments were excluded. Primary outcomes included fracture union assessed by a modified RUST score ≥ 11 at 12 months, malalignment assessed by postoperative radiographs and CT scan at one year, functional evaluation of the knee and ankle using the Lysholm and AOFAS scores, respectively, and complication rates. At the end of follow-up, 43 patients without fibular fixation (HIMB group) and 34 with fixation (HIMBF group) were analyzed. The nonunion rate was 4.7 % in the HIMB group and 5.9 % in the HIMBF group, with no significant difference. Fracture healing progression was similar between groups. Malunion occurred in 18.6 % of the HIMB group and 11.8 % of the HIMBF group, without statistical significance. There were no significant differences in complication rates or in knee and ankle functional outcomes at one year. Concomitant fibular fixation does not influence nonunion or malunion rates, does not increase complication rates, and does not affect knee or ankle function in the treatment of extra-articular distal tibial fractures stabilized with locked intramedullary nails.