SLR - May 2021 - Peyman Danesh

External Fixator Combined with Three Different Fixation Methods of Fibula for Treatment Of Extra-Articular Open Fractures of Distal Tibia and Fibula: A Retrospective Study

Reference: Sun DD, Lv D, Zhou K, Chen J, Gao LL, Sun ML. External Fixator Combined with Three Different Fixation Methods of Fibula for Treatment Of Extra-Articular Open Fractures of Distal Tibia and Fibula: A Retrospective Study. BMC Musculoskelet Disord. 2021;22(1):1. Published 2021 Jan 4. 

Level of Evidence: III

Scientific Literature Review

Reviewed By: Peyman Danesh, DPM
Residency Program: Long Island Jewish Forest Hills – Queens, NY

Podiatric Relevance: Open fractures of distal tibia and fibula are generally caused by high-energy trauma and require external fixator fixation. Previous studies were performed with the tibia fixated with an external fixator, intramedullary nail or plates, while the fibula was either not fixated, or fixated with intramedullary nail or plates. Results showed that fibula fixation was helpful to restore tibial length, reduced lateral movement of fracture and maintained stability of tibia in shaft direction. However, there were no studies using K-wires for fibula fixation. Purpose of this study was to compare the efficacy of external fixation only, external fixation combined with plate-screw fixation and external fixation combined with K-wire internal fixation for treatment of open fractures of distal tibia and fibula. 

Methods: Retrospective study performed from January 2017 to July 2019 on all open distal tibia and fibula fractures. Overall, 91 patients were enrolled, 35 patients were treated with only external fixation, 30 patients treated with external fixation combined with plate-screw fixation and 26 patients treated with external fixation combined with K-wire fixation. The operation time, intraoperative blood loss, surgical and implants cost, fracture healing time, postoperative complications and AOFAS scores at the last follow-up were recorded and compared in the three groups. 

Results: Out of the 91 patients, 87 followed up regularly and four were lost to follow up. Follow up period ranged from five to 35 months, with an average of 14.2 months. The external fixator combined with K-wire fixation group was found to be statistically significant for shortened operation time and fracture healing time, reduced costs and complications of fracture healing compared to the other groups. The external fixator combined with plate-screw fixation was statistically significant for prolonged operation time, but no advantages in regard to fracture healing, postoperative complications or functional recovery. There was no significant difference among the three groups in regard to postoperative infections, intraoperative blood loss or the score of ankle function.

Conclusions: Open fractures of the distal tibia and fibula are complex injuries caused by high-energy trauma and can lead to delayed union or nonunion or even traumatic arthritis if not treated properly. This study demonstrated that external fixation combined with K-wire fixation group had great ankle function rates with decreased operation and fracture healing time, reduced costs and less complications compared to external fixation alone or combined with plate-screw fixation. This study had limitations as it is a retrospective study with small sample size. Future randomized control studies need to be performed to confirm results of this study. 

Educational Opportunities

Upcoming