Fixation of Distal Fibula Fractures Associated with Extra-articular Distal One-third Tibia Fractures – Is It Necessary?

Introduction: Fractures involving the distal third of both bone leg are one of the common long bone fractures with significant concern owing to the amount of soft-tissue damage incurred and poor prognosis with respect to fracture fixation. Aim: The aim of the study is to evaluate whether fibula fixation is necessary along with internal fixation of extra-articular distal tibia fractures by comparing the clinico-radiological and functional outcome of patients of extra-articular distal third tibia fractures with fibula “fixed” and fibula “not fixed” group. Materials and Methods: A prospective cohort study with a sample size of 30 patients was conducted in Sri Ramachandra Institute of Higher Education and Research between March 2023 and May 2024. Fibula fixation was done in one group, and the fibula was not fixed in the control group. Research methodology includes radiological evaluation for coronal and sagittal plane malalignment, Radiographic Union Score for Tibial fractures (RUST) scoring, and clinically, rotational malalignment and presence of post-operative infection. All cases were followed up for a minimum duration of 6 months to assess union of tibia fractures in both groups. Results: Tibial bone union rate was better in the fibula not fixed (control) group compared to the fibula fixed group (P = 0.032), confirmed by the RUST scoring (P = 0.047), which was statistically significant. Conclusion: There was no significant improvement with additional fibula fixation in the healing of distal tibia fractures, but rather causes greater morbidity in terms of wound infections and delayed healing of the tibia. This clearly demonstrates that fibula fixation in extra-articular distal tibia fractures when the fracture does not affect the syndesmosis or ankle mortise is not necessary, and is associated with a higher risk of tibial non-union. Keywords: Distal tibia, fibula, fracture, fixation, osteosynthesis.