Intramedullary Device Fixation for Distal Fibula Fractures Associated with Distal Tibia Injuries: Clinical Outcomes and Practice Implications

Background: Extra-articular fractures of the distal tibia and fibula, typically resulting from axial compression, bending or low-energy twisting forces, pose considerable management challenges. The necessity of fixing fibular fractures at the same distal third level, particularly when intramedullary nailing is employed for tibial fractures, remains a subject of debate. Methods: This study evaluated the radiological outcomes, union rates and postoperative complications following intramedullary device fixation of fibular fractures associated with extra-articular distal tibia fractures. Outcome measures included time to radiographic union, operative time, incidence of wound complications and functional outcomes assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Olerud Molander Ankle Score (OMAS). Results: All patients achieved union of both tibia and fibula at a mean of 12 weeks. Functional outcomes were favorable, with a mean AOFAS score of 87 at six months. The majority of patients experienced satisfactory ankle function and minimal complications. Conclusion: Intramedullary fixation of distal-third fibular fractures, in combination with tibial nailing for distal tibia fractures, yields excellent radiological and functional outcomes. This technique may offer a reliable alternative to plating in appropriately selected cases. Background: Extra-articular fractures of the distal tibia and fibula, typically resulting from axial compression, bending or low-energy twisting forces, pose considerable management challenges. The necessity of fixing fibular fractures at the same distal third level, particularly when intramedullary nailing is employed for tibial fractures, remains a subject of debate. Methods: This study evaluated the radiological outcomes, union rates and postoperative complications following intramedullary device fixation of fibular fractures associated with extra-articular distal tibia fractures. Outcome measures included time to radiographic union, operative time, incidence of wound complications and functional outcomes assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Olerud Molander Ankle Score (OMAS). Results: All patients achieved union of both tibia and fibula at a mean of 12 weeks. Functional outcomes were favorable, with a mean AOFAS score of 87 at six months. The majority of patients experienced satisfactory ankle function and minimal complications. Conclusion: Intramedullary fixation of distal-third fibular fractures, in combination with tibial nailing for distal tibia fractures, yields excellent radiological and functional outcomes. This technique may offer a reliable alternative to plating in appropriately selected cases.