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⁎ J. Peng and X. Long contributed equally to this research and should be considered co-first authors.
There is no consensus on whether a fibular fracture should be fixed when a concurrent
extra-articular distal tibia fracture is managed with intramedullary nails. We evaluated
the use of fibular fixation in a meta-analysis of randomized trials and observational
studies. Two researchers independently assessed the quality of eligible studies and
extracted the data. We analyzed 4 trials with a pooled sample of 283 patients (mean
age, 24 to 43 years; 141 men), 94 who had undergone fibular fixation and 189 who had
not. Two randomized trials assessed on the Cochrane risk-assessment criteria were
determined to have a moderate risk of bias, and 2 retrospective cohort studies evaluated
with the Newcastle-Ottawa Scale were considered to be high quality. Tibia malalignment
at follow-up times ranging from 12 to 72 weeks was reported in 20% (19/94) of patients
in the fibular-fixation group and 67% (126/189) of patients in the nonfixation group,
indicating that fibular fixation was significantly associated with a lower risk of
malalignment (risk ratio, 0.34; 95% confidence interval (CI) 0.13 to 0.92;
p = .03). The groups did not differ in the proportion of patients with malalignment
immediately after surgery, delayed union, nonunion, or infection. When distal extra-articular
tibia-fibular fractures are treated with intramedullary nails, fibular fixation may
decrease the risk of late malalignment. Further randomized controlled trials with
higher quality are required to verify the result.
Level of clinical evidence
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Published online: November 17, 2020
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Conflict of Interest: None reported.
© 2020 by the American College of Foot and Ankle Surgeons. All rights reserved.
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