PMID- 28584887
OWN - NLM
STAT- MEDLINE
DCOM- 20181015
LR  - 20181113
IS  - 1863-9941 (Electronic)
IS  - 1863-9933 (Linking)
VI  - 44
IP  - 3
DP  - 2018 Jun
TI  - Intramedullary tibial nailing of distal tibiofibular fractures: additional 
      fibular fixation or not?
PG  - 433-441
LID - 10.1007/s00068-017-0797-3 [doi]
AB  - INTRODUCTION: The anatomy of the distal tibia accounts for reduced biomechanical 
      stability and higher complication rates when treating distal tibiofibular 
      fractures with an intramedullary tibia nail (IMTN). The goal of this study was to 
      identify variables that affect the stability of IMTN. We assessed the value of 
      additional fibular fixation, angular stable interlocking screws (ASLS) and 
      multiplanar screw configuration in IMTN. PATIENTS AND METHODS: A retrospective 
      cohort study was performed including 184 distal tibial fractures and associated 
      fibula fracture treated with IMTN. Relevant demographic, fracture-related (type 
      and level of the tibia and fibula fracture) and operative variables (depth of the 
      nail, screw type and configuration, use of polar screws, fibular fixation) were 
      studied. Coronal and sagittal alignment was assessed directly and 3-6 months 
      after IMTN. Loss of reduction (LOR) was classified as 5-9 degrees  or >/=10 degrees . RESULTS: 
      48.4% of the patients showed >/=5 degrees  LOR in one or both planes. Coronal LOR 5 degrees -9 degrees  
      significantly correlated with low tibial fractures (p = 0.034), AO/OTA type 43 
      distal tibial fractures (p = 0.049), and sagittal LOR 5 degrees -9 degrees  (p = 0.015). Although 
      sagittal LOR 5 degrees -9 degrees  was associated with fibular fractures (non-fixated 
      suprasyndesmotic, p = 0.011), conversely we could not demonstrate the added value 
      of (suprasyndesmotic) fibula fixation in IMTN. Coronal LOR >/=10 degrees  significantly 
      correlated with AO/OTA type 43 distal tibial fractures (p = 0.009). In contrast 
      to multiplanar configuration, we found a clear benefit of ASLS in distal IMTN 
      locking. CONCLUSIONS: The level of the tibial fracture (AO/OTA type) and 
      (suprasyndesmotic) fibular fractures were the main determinants of LOR after 
      IMTN. ASLS was found to increase the stability of IMTN. Due to heterogeneity, 
      however, we could not demonstrate the value of fibular fixation in IMTN. 
      Therefore, a future prospective study with uniform treatment strategy for IMTN of 
      distal tibiofibular fractures, with or without fixation of the fibula, is 
      mandatory.
FAU - Van Maele, M
AU  - Van Maele M
AD  - Faculty of Medicine, KU Leuven, University of Leuven, 3000, Leuven, Belgium.
FAU - Molenaers, B
AU  - Molenaers B
AD  - Department of Orthopaedic Surgery, University Hospitals Leuven, 3000, Leuven, 
      Belgium.
FAU - Geusens, E
AU  - Geusens E
AD  - Department of Radiology, University Hospitals Leuven, 3000, Leuven, Belgium.
FAU - Nijs, S
AU  - Nijs S
AD  - Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, 
      Leuven, Belgium.
AD  - Department of Development and Regeneration, KU Leuven, University of Leuven, 
      3000, Leuven, Belgium.
FAU - Hoekstra, H
AU  - Hoekstra H
AD  - Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, 
      Leuven, Belgium. harm.hoekstra@uzleuven.be.
AD  - Department of Development and Regeneration, KU Leuven, University of Leuven, 
      3000, Leuven, Belgium. harm.hoekstra@uzleuven.be.
LA  - eng
PT  - Journal Article
DEP - 20170605
PL  - Germany
TA  - Eur J Trauma Emerg Surg
JT  - European journal of trauma and emergency surgery : official publication of the 
      European Trauma Society
JID - 101313350
SB  - IM
MH  - Adult
MH  - *Bone Screws
MH  - Female
MH  - Fibula/*surgery
MH  - Fracture Fixation, Internal/*instrumentation
MH  - *Fracture Fixation, Intramedullary
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Tibial Fractures/*surgery
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Distal tibial fractures
OT  - Fibular fixation
OT  - Outcome
EDAT- 2017/06/07 06:00
MHDA- 2018/10/16 06:00
CRDT- 2017/06/07 06:00
PHST- 2016/10/19 00:00 [received]
PHST- 2017/05/29 00:00 [accepted]
PHST- 2017/06/07 06:00 [pubmed]
PHST- 2018/10/16 06:00 [medline]
PHST- 2017/06/07 06:00 [entrez]
AID - 10.1007/s00068-017-0797-3 [pii]
AID - 10.1007/s00068-017-0797-3 [doi]
PST - ppublish
SO  - Eur J Trauma Emerg Surg. 2018 Jun;44(3):433-441. doi: 10.1007/s00068-017-0797-3. 
      Epub 2017 Jun 5.