A prospective randomized comparative study on fractures of lower third of both bones of the leg treated by interlock nailing of tibia with or without fixation of fibula


  • Deepak Kumar Devatheya Department of Orthopaedics, B.M.H. Hospital, Sumerpur, Pali, India
  • Rajendra Prasad Assat Department of Orthopaedics, S.M.S. Medical College, Jaipur, India
  • Ratanlal Dayama Department of Orthopaedics, S.M.S. Medical College, Jaipur, India
  • Kanta Prasad Meena Department of Orthopaedics, S.M.S. Medical College, Jaipur, India




Tibia, Fibula, Interlocking nail, Valgus angulation, Ankle score


Background: In the treatment of fractures of the distal third of tibia and fibula treated by interlocking nail of tibia, the role of fixing the fibular fracture is not clearly defined. This study was conducted to assess the benefits of fixation of fibular fracture in distal third leg bones fractures.

Methods: 95 patients were enrolled into study and divided randomly into two groups based on whether fibula fixed or not with interlock intramedullary nailing tibia. Patients were followed for an average period of 11 months both radiologically and clinically.

Results: We observed that the average valgus angulation was significantly less (P =0.001) in the group where fibula was fixed. The outcome of the two groups for clinical ankle score, time of union and complication showed no difference (P ≥0.05).

Conclusions: We concluded that fixation of fibula decrease the malalignment of tibia in distal third fractures of tibia and fibula treated with interlocking nail of tibia.



Kumar A, Charlebois SJ, Cain EL, Smith RA, Daniels AU, Crates JM. Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Joint Surg Am. 2003;85:604-8.

Bedi A, Le TT, Karunakar MA. Surgical treatment of nonarticular distal tibia fractures. J Am Acad Orthop Surg. 2006;14:406-16.

Chapman MW. Fractures of the tibial and fibular shafts. In: Chapman MW, editor. Chapman’s orthopaedic surgery. 3rd edition, volume 1. Philadelphia: Lippincott Williams and Wilkins; 2001: 755-810.

Browner BD, Jupiter JB, Levine AM, Trafton PG. Tibial shaft fractures. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma. 3rdedition. volume 2. Philadelphia: Saunders; 2003: 2131-2255.

Schoot DKE. Outer AJD, Bode PJ, Obsermann WR, Vugt AB. Degenerative changes at the knee and ankle related to mal-union of tibial factures – 15 year follow up of 88 patients. J Bone Joint Surg Br. 1996;78:722-5.

Kettelkamp DB, Hillbery BM, Murrish DE, Heck DA. Degnerative arthritis of the knee secondary to fracture mal-union. Clin Orthop. 1988;234:159-69.

McKellop H.A., Llinas A., Sarmiento A. Effects of tibialmalalignment on the knee and ankle. Orthop. Clin. North Am. 1994;25:415-23 .

Teitz CC, Carter DR, Frankel VH, Washington S. Problems associated with tibial fractures with intact fibula. J Bone Joint Surg Am. 1980;62:770-6.

Weber TG, Harrington RM, Henley MB, Tencer AF. The role of fibular fixation in combined fractures of the tibia and fibula: a biomechanical investigation. J Orthop Trauma. 1997;11(3):206-11.

Merchant TC, Dietz FR. Long term follow up after fractures of the tibial and fibular shafts. J Bone Joint Surg Am. 1989;71:599-606.

Puno RM, Vaughan JJ, Fraunhofer JA, Stetten ML, Johnson JR. A method of determining the angular malalignments of the knee and ankle joints resulting from a tibial mal-union. Clin Orthop. 1987;223:213-9.

Johner R, Wruhs O. Calssification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop. 1983;178:7-25.

Puno RM, Teynor JT, Junji N, Gustilo R. Critical analysis of results of treatment of 201 tibial shaft fractures. Clin Orthop. 1986;212:113-21.

Schmidt AH, Finkemeier CG, Tornetta P. Treatment of closed tibial fractures. J Bone Joint Surg Am. 2003;85:352-68.






Original Research Articles