Role of fibula in healing of closed diaphyseal tibial fractures treated with intramedullary interlocking nail

Abstract

Isolated tibial shaft fractures with intact fibula are a fairly common injury. Hospital records often fail to mention the intact fibula in such injuries. Many studies blame that with an intact fibula, tibiofibular length discrepancy develops resulting complications associated with the management of tibia fractures like delayed union, non-union, and malunion. A prospective study in 59 patients of tibial shaft fractures with 33 having fibula fracture (FF) and 26 patients with an intact fibula(IF) were treated by closed intramedullary interlocking nail between June 2019 to July 2020. Radiological follow up were at 6 weeks, 3 months, 6 months. The final functional evaluation was done with Johner and Wruh’s criteria at the end of 6 months.The mean duration of surgery in group IF was 106.62 minutes wherein group FF was 97.91 minutes The radiological union was early with a mean union rate of 19.09 weeks in group FF compared to group IF where the mean was 22.23 weeks. The percentage of nonunion was 3.85% in group IF. 4 patients had a deformity where the level of tibia fracture was lower 1/3 diaphyseal with fibula fracture at the same level. At the final follow up the functional score had no significance. The union of a tibial shaft fracture was slower in patients with an intact fibula compared to those with a fractured fibula. Although the intact fibula was more proven for the delayed union, non-union, it prevents malalignment.