Prophylactic fibulotomy during external fixation for tibia fractures: a retrospective study on reducing nonunion incidence
DOI:
https://doi.org/10.18203/2320-6012.ijrms20251279Keywords:
Fracture healing, External fixation, Nonunion, Prophylactic fibulotomy, Tibial fracturesAbstract
Background: Tibial fractures are prevalent long bone injuries that can result in nonunion, especially when treated with external fixation. Prophylactic fibulotomy has been suggested to improve fracture healing. This study evaluates the effectiveness of prophylactic fibulotomy in reducing nonunion rates in patients undergoing external fixation for tibial fractures.
Methods: A retrospective cohort study was conducted at the National Orthopaedic Hospital, Igbobi, Lagos, Nigeria, analyzing patient records from January 2022 to December 2024. Associations between prophylactic fibulotomy and postoperative complications were assessed using chi-square tests, while t-tests compared time to union between fibulotomy and non-fibulotomy groups. A p value of less than 0.05 was considered statistically significant.
Results: The study included 60 patients, predominantly males (53.3%) aged 40 years and above (58.3%). Distal fractures were most common (36.7%). Union was achieved in 70.0% of cases, with a significant association between fibulotomy and union status (χ²=18.367, p<0.005). The mean time to union was 15.8±1.4 weeks for patients who underwent fibulotomy, compared to 18.2±1.8 weeks for those who did not, indicating a significant difference (t=-5.179, p<0.05).
Conclusions: Prophylactic fibulotomy during external fixation of tibial fractures is associated with higher union rates and shorter time to union, suggesting it may be a beneficial adjunctive procedure in managing tibial fractures requiring external fixation.
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References
Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691–7. DOI: https://doi.org/10.1016/j.injury.2006.04.130
Pagliaro AJ, Parvizi J. Tibial shaft fractures. Orthop Clin North Am. 2004;35(1):2941.
Muller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Berlin: Springer; 1990. DOI: https://doi.org/10.1007/978-3-642-61261-9
Trafton PG. Tibial shaft fractures. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal Trauma. Philadelphia: WB Saunders; 1992:2057–147.
Koval KJ, Zuckerman JD. Handbook of Fractures. 3rd ed. Lippincott Williams & Wilkins; 2006.
Alho A. Closed and open tibial shaft fractures treated by intramedullary nailing. Clin Orthop Relat Res. 1993 May;(287):214-22.
Sanders RW, Jersinovich I, Anglen JO, DiPasquale T, Herscovici D. The treatment of open tibial shaft fractures using an interlocked intramedullary nail without reaming. J Orthop Trauma. 1994;8(6):504-10. DOI: https://doi.org/10.1097/00005131-199408060-00008
Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br. 1995;77(3):417–21. DOI: https://doi.org/10.1302/0301-620X.77B3.7744927
Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta P, Sprague S, Schemitsch EH. Surgeons' preferences for the operative treatment of fractures of the tibial shaft. An international survey. J Bone Joint Surg Am. 2001;83(11):1746-52. DOI: https://doi.org/10.2106/00004623-200111000-00020
Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Joint Surg Am. 1986;68(9):877-87. DOI: https://doi.org/10.2106/00004623-198668060-00009
Keating JF, O'Brien PJ, Blachut PA, Meek RN, Broekhuyse HM. Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. J Bone Joint Surg Am. 1997;79(3):334–41. DOI: https://doi.org/10.2106/00004623-199703000-00003
Court-Brown CM, Christie J, McQueen MM. Closed intramedullary tibial nailing: its use in closed and type I open fractures. J Bone Joint Surg Br. 1990;72(4):605–11. DOI: https://doi.org/10.1302/0301-620X.72B4.2380211
Karladani AH, Granhed H, Kärrholm J. Intramedullary nailing versus percutaneous plating for tibial fractures: A prospective randomized study. J Orthop Trauma. 2007;21(3):163–8.
Chan DS, Court-Brown CM. The epidemiology of open fractures in adults. Injury. 2013;44(8):1145-8.
Giannoudis PV, Papakostidis C, Roberts C. A review of the management of open fractures of the tibia and femur. J Bone Joint Surg Br. 2006;88(3):281-9. DOI: https://doi.org/10.1302/0301-620X.88B3.16465
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. J Bone Joint Surg Am. 1976;58(4):453–8. DOI: https://doi.org/10.2106/00004623-197658040-00004
Tornetta P, Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br. 1994;76(1):13-9. DOI: https://doi.org/10.1302/0301-620X.76B1.8300656
Blachut PA, Meek RN, O'Brien PJ. External fixation versus interlocking intramedullary nailing for open fractures of the tibial shaft. J Bone Joint Surg Am. 1990;72(9):1462–71. DOI: https://doi.org/10.2106/00004623-199072050-00013
Keating JF, Blachut PA, O'Brien PJ, Court-Brown CM. Reamed nailing of open tibial fractures: does the antibiotic bead pouch reduce the deep infection rate? J Orthop Trauma. 1996;10(5):298–303. DOI: https://doi.org/10.1097/00005131-199607000-00002
Wiss DA, Stetson WB. Tibial fractures. In: Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia: Lippincott-Raven; 1996:2227–91.
Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: A new classification of type III open fractures. J Trauma. 1984;24(8):742–6. DOI: https://doi.org/10.1097/00005373-198408000-00009
Court-Brown CM. Complications of tibial fracture. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Rockwood and Green’s Fractures in Adults. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2006:2080-125.
Sarmiento A, Latta LL. Functional fracture bracing: Tibial fractures. Clin Orthop Relat Res. 1981;(160):2–11.
Webb LX, Bosse MJ. Spiral fractures of the tibia: Isolated and associated injuries. J Orthop Trauma. 1994;8(4):260-5.
Ruedi TP, Murphy WM. AO Principles of Fracture Management. Stuttgart: Thieme; 2000.
Maffulli N, Testa V, Capasso G, Bifulco G, Benvenuti D. The management of segmental tibial shaft fractures using the Ilizarov method. Injury. 1995;26(5):299–304. DOI: https://doi.org/10.1016/0020-1383(95)00037-A
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007 Nov;21(10 Suppl):S1-133. DOI: https://doi.org/10.1097/00005131-200711101-00001
Leung KS, Shen WY, So WS, Mui LT, Grosse A. Interlocking intramedullary nailing for displaced tibial shaft fractures: Comparison of conventional and locked nailing. J Trauma. 1990;30(11):1525-30.
Obremskey WT, Cutrera NJ, Kidd CM, Mulligan M, Cox M, Jahangir AA. Prospective randomized trial of reamed versus nonreamed intramedullary nails in open tibia fractures. J Orthop Trauma. 2007;21(10):535-41.
Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. 1998;29(7):529–34. DOI: https://doi.org/10.1016/S0020-1383(98)00125-9
Brumback RJ, Virkus WW. Intramedullary nailing of the femur and tibia: Reamed versus nonreamed. J Am Acad Orthop Surg. 2000;8(2):83-90. DOI: https://doi.org/10.5435/00124635-200003000-00002
Bhandari M, Guyatt GH, Tornetta P, Swiontkowski MF, Sanders D, Schemitsch EH, et al. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008;90(12):2567-78. DOI: https://doi.org/10.2106/JBJS.G.01694
Kakar S, Tornetta P. Open fractures of the tibia treated by immediate intramedullary tibial nail insertion without reaming: A prospective study. J Orthop Trauma. 2007;21(8):536-41. DOI: https://doi.org/10.1097/BOT.0b013e3180336923
Joshi D, Ahmed A, Krishna L, Lal Y, Sharma V. Non-union of the tibia treated with closed intramedullary nailing. Int Orthop. 2000;24(4):250-2.
Court-Brown CM, Bugler KE, Clement ND, Duckworth AD, McQueen MM. The epidemiology of open fractures in adults: A 15-year review. Injury. 2012;43(6):891-7. DOI: https://doi.org/10.1016/j.injury.2011.12.007
Naique SB, Pearse M, Nanchahal J. Management of severe open tibial fractures: The need for combined orthopedic and plastic surgical treatment in specialist centers. J Bone Joint Surg Br. 2006;88(3):351–7. DOI: https://doi.org/10.1302/0301-620X.88B3.17120
Lefaivre KA, Guy P, Chan H, Blachut PA. Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma. 2008;22(8):525-9. DOI: https://doi.org/10.1097/BOT.0b013e318180e646
Bone LB, Sucato D, Stegemann PM, Rohrbacher BJ. Displaced isolated fractures of the tibial shaft treated with either a cast or intramedullary nailing: An outcome analysis of matched pairs of patients. J Bone Joint Surg Am. 1997;79(10):1336-41. DOI: https://doi.org/10.2106/00004623-199709000-00007
Drosos GI, Karnezis IA. Intramedullary nailing of open tibial fractures. Does primary union vary with the level of the fracture? Injury. 2004;35(7):518–23.
Court-Brown CM, McBirnie J, Hughes SP. Intramedullary nailing of tibial diaphyseal fractures in the elderly. Injury. 1995;26(8):485-7.
Chiu FY, Chen CM, Lin CF, Lo WH. Treatment of open tibial shaft fractures with interlocking nailing. Clin Orthop Relat Res. 1997;(338):20-8.
Behrens F, Searls K. External fixation of the tibia. Basic concepts and prospective evaluation. J Bone Joint Surg Br. 1986;68(2):246-54. DOI: https://doi.org/10.1302/0301-620X.68B2.3514629
Ziran BH, Smith WR, Anglen JO, Tornetta P. External fixation: How to make it work. J Bone Joint Surg Am. 2007;89(1):162-73. DOI: https://doi.org/10.2106/00004623-200707000-00028
Tornetta P, Tiburzi D. Reamed versus nonreamed antegrade femoral nailing: A prospective, randomized trial. J Orthop Trauma. 2000;14(1):15-9. DOI: https://doi.org/10.1097/00005131-200001000-00004
Dillin L, Slabaugh P. The role of anterior decompression and arthrodesis in the treatment of spinal metastases. Clin Orthop Relat Res. 1982;(169):156–68.
Wiss DA, Stetson WB. Segmental tibial fractures: Results of treatment with interlocking nails. Clin Orthop Relat Res. 1995;(315):175-83.
Chapman MW, Olson SA. Open fractures. In: Rockwood and Green’s Fractures in Adults. 4th ed. Philadelphia: Lippincott-Raven; 1996:305–52.
McKee MD, Schemitsch EH, Waddell JP. Complications of intramedullary nailing of the tibia. J Bone Joint Surg Br. 1995;77(3):432-9.
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