The role of fibular fixation in the treatment of adolescent displaced distal tibial physeal fractures To Fix or Not to Fix?

Background: In treating adolescent displaced distal tibial physeal/fibula fractures, the role of fibular fixation is not clearly defined.

Purpose: This study aimed to assess the role of fibular fixation in adolescent displaced distal tibial physeal/fibula fractures and its significance with functional outcomes.

Study design: Retrospective cohort study.

Methods: 50 patients with adolescent displaced distal tibial physeal/fibula fractures were enrolled into the study and divided into two groups based on whether the fibula was fixed (group A) or not (group B). The two groups were compared for differences in demographic data, operative time, intraoperative fluoroscopy times, weight-bearing time, union time, and complications. Clinical and functional outcomes were regularly assessed using the premature epiphyseal closure (PPC) rate and the American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-hindfoot foot scoring system.

Results: There were significant differences in operative time (p < 0.001), intraoperative fluoroscopy times (p < 0.001), fibula healing time (p < 0.001) and weight-bearing time (p < 0.001) between the two groups. In contrast, fibular fixation did not affect the outcome of the clinical ankle score (p = 0.484).

Conclusion: For adolescent patients with distal tibial physeal fractures and concurrent fibula fractures, fibular fixation can significantly shorten fibular healing time and enable earlier weight-bearing. This fixation may also improve the ability to achieve and maintain the reduction in complex distal tibial physeal fractures. However, routine fibular fixation is not recommended and should be considered based on fracture characteristics such as syndesmotic instability, severe fibular displacement/shortening, or challenges in maintaining tibial reduction.

Level of evidence: Level III, retrospective cohort study.