From the Research
The statement that a tibial fracture with an intact fibula is more likely to be difficult to treat and has a higher chance of nonunion is false, according to the most recent and highest quality study. The study published in 2022 1 found that a fibular osteotomy can increase axial tibial loading, which can help to promote bone healing, but it did not conclude that an intact fibula is a disadvantage in the treatment of tibial fractures. Another study published in 2017 2 also found that an intact fibula was not a disadvantage in the treatment of tibial diaphysis fractures with intramedullary nailing.
Some key points to consider when treating tibial fractures with an intact fibula include:
- The use of intramedullary nailing with reaming, which can help to promote bone healing by increasing stability at the fracture site 3
- The potential need for fibular osteotomy to increase axial tibial loading and promote bone healing 1
- The importance of careful assessment of the fracture pattern and consideration of weight-bearing restrictions for longer periods 4
- The risk of nonunion is particularly high in diaphyseal (shaft) fractures of the tibia when the fibula remains intact, especially in the presence of other risk factors such as open fractures, significant soft tissue damage, or compromised blood supply to the area 5
Overall, while an intact fibula may present some challenges in the treatment of tibial fractures, it is not necessarily a disadvantage, and the use of appropriate treatment strategies can help to promote bone healing and minimize the risk of nonunion.