DISTAL THIRD TIBIAL FRACTURE SURGERY WITH FIBULAR FIXATION: IS IT NECESSARY FOR UNION AND ALIGNMENT?

Year 2023, Volume: 30 Issue: 3, 308 - 315, 23.09.2023

Necmettin Turgut , Ahmet İnce , Meric Unal

https://doi.org/10.17343/sdutfd.1219295

Abstract

Objective
The management of distal third tibial fractures remain
controversial. The aim of the present study was to
evaluate whether concurrent fibular fixation changes
union rates and aids in alignment in the case of distal
third tibia fractures.
Material and Method
The study included 106 distal third tibia fracture
operation cases in which the distance from the fracture
to the plafond was between 3-12 cm at a single centre
between January 2016 and June 2020. The patients
were divided into three groups according to the status
of the fibula: Group 1 (without fibular fixation with
the presence of a fibula fracture, 47 cases), Group
2 (concurrent fibular fixation with the presence of a
fibular fracture, 38 cases) and Group 3 (intact fibula,
21 cases). All fibular fixation surgeries were performed
with locked plates (LCP) and tibial fixation with either
LCP or intramedullary nailing (IMN). The primary
outcome measures were union and alignment. Age,
gender, AO classification, fibula fracture location,
presence of an open fracture, implant type and time
delay for surgery were also assessed.
Results
None of the variables except the presence of an open
fracture was significant for the union rates or alignment.
The union rate was significantly less if there was an
open fracture in the concurrent fibular fixation group
(p<0.001). Closed fractures were associated with
better union rates according to the logistic regression
analysis (OR=5,00 (%95 CI 2,24-11,48).
Conclusion
The present study suggests that a concurrent fibular
fixation in the case of distal third tibia fractures
improves neither the union rates nor the alignment.
Therefore, we conclude that a fibular fixation is not a
necessity in achieving better results and should not
be performed in case of an open fracture considering
the lesser union rate and the burden involved with an
additional surgery.

Keywords

distal tibia fracture, fibula fracture, nonunion, Gustilo Anderson classification, intramedullary nailing, concurrent fibular fixation

DİSTAL TİBİA KIRIKLARINDA FİBULAR FİKSASYON: KAYNAMA VE DİZİLİM AÇISINDAN GEREKLİ MİDİR?

Abstract

Amaç
Distal 1/3 tibia kırıklarının tedavi yönetimi tartışmalıdır.
Bu çalışmanın amacı aynı zamanda yapılan fibular
fiksasyonun kaynama oranlarını arttırıp arttırmadığını
ve dizilim açısından gerekliliğini değerlendirmektir.
Gereç ve Yöntem
Bu çalışmaya distal 1/3 tibia kırığı nedeniyle tek bir
merkezde Ocak 2016 ile Haziran 2020 arasında opere
edilmiş 106 hasta alındı. Kırıklar plafond seviyesinden
3-12 cm arası mesafede lokalize olarak belirlendi.
Hastalar fibulanın durumuna göre üç gruba ayrıldı:
Grup 1 (bir fibula kırığı var ancak fibular fiksasyon yapılmamış,
47 vaka), Grup 2 (bir fibula kırığı var, eş
zamanlı fibular fiksasyon yapılmış, 38 vaka) and Grup
3 (intakt fibula, 21 vaka). Tüm fibular fiksasyon cerrahileri
kilitli kompresyon plakları ile, tibial fiksasyon ise
kiltli kompresyon plakları veya intramedüller çivileme
ile yapıldı. Primer sonuç ölçütleri kaynama ve dizilim
olarak belirlendi. Yaş, cinsiyet, AO sınıflaması, fibula
kırık seviyesi, açık kırık varlığı, implant tipi ve cerrahiye
kadar geçen süre değerlendirildi.
Bulgular
Açık kırık varlığı haricindeki değişkenlerin hem kaynama
oranlarını hem de dizilimi etkilemediği izlendi.
Kaynama oranı eş zamanlı fibula fiksasyon grubunda
açık kırık varlığında anlamlı oranda daha düşük saptandı
(p<0.001). Kapalı kırıklar lojistik regresyon analizi
yapıldığında daha iyi kaynama oranlarına sahipti
(OR=5,00 (%95 CI 2,24-11,48).
Sonuç
Mevcut çalışma distal 1/3 tibia kırıklarında eş zamanlı
bir fibular fiksasyon ameliyatının ne kaynama oranları
ne de dizilim üzerine olumlu etkisi olmadığını gösterdi.
Bundan dolayı, daha iyi sonuçlar almak için distal
tibia kırıklarında bir fibular fiksasyon cerrahisi zorunluluk
değildir ve açık kırık varlığında hem ek cerrahinin
getirdiği yük hem de daha düşük kaynama oranı nedeni
ile yapılmamasını önermekteyiz.

Keywords

distal tibia kırığı, fibula kırığı, kaynamama, Gustilo Anderson sınıflaması, intramedüller çivileme, eş zamanlı fibular fiksasyon

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