Fixation of Distal Fibula Fractures Associated with Extra-articular Distal One-third Tibia Fractures - Is It Necessary?

Sep 29, 2026

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The study assesses whether adding fibula fixation to internal fixation improves outcomes in extra-articular distal one-third tibia fractures. A prospective cohort of 30 patients (March 2023 to May 2024) compared fibula “fixed” versus “not fixed” groups using radiological alignment assessment, RUST scoring for union, and clinical evaluation of rotational malalignment and post-operative infection over at least 6 months. Results showed better tibial union in the control group, with no significant healing benefit from fibula fixation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Introduction

Aim

Materials and Methods

Outcomes and Follow-up

Results

Conclusion

Keywords

Original Article Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 406-412 Fixation of Distal Fibula Fractures Associated with Extra-articular Distal One-third Tibia Fractures – Is It Necessary? Kishore Ragavendra Rajesh1, Sundar Suriyakumar1, J. K. Giriraj Harshavardhan1, C. Sitsabesan1, M. Tavfiq1, S. Aravind1 Learning Point of the Article: Fibula fixation in extra-articular distal third tibial fractures is to be considered in selected cases, keeping in mind the future prognosis of tibial fracture healing. Abstract Introduction: Fractures involving the distal third of both bone leg are oneof the commonlong bone fractures with significant concern owing to the amount of soft-tissue damage incurred and poor prognosis with respect to fracture fixation. Aim: The aim of the study is to evaluate whether fibula fixation is necessary alongwith internal fixation ofextra-articular distal tibia fractures by comparing the clinico-radiological and functional outcome of patients ofextra-articular distal third tibia fractures with fibula “fixed” and fibula“not fixed” group. Materials and Methods: A prospective cohort study with a sample size of 30 patients was conducted in Sri Ramachandra Institute of Higher Education and Research between March 2023 and May 2024. Fibula fixation was done in one group, and the fibula was not fixed in the control group. Research methodology includesradiological evaluation for coronaland sagittalplane malalignment, RadiographicUnion Scorefor Tibial fractures (RUST) scoring, and clinically, rotational malalignment and presence of post-operative infection. All cases were followed up for a minimum duration of 6 months to assessunion of tibia fracturesin both groups. Results: Tibial bone union rate was better in the fibula not fixed (control) group compared to the fibula fixed group (P = 0.032), confirmed by the RUST scoring (P = 0.047), which was statistically significant. Conclusion: There was no significant improvement with additional fibula fixation in the healing of distal tibia fractures, but rather causes greater morbidity in terms ofwound infections and delayed healing of the tibia. This clearly demonstrates that fibula fixation in extra-articular distal tibia fractures when the fracture does not affect the syndesmosis or ankle mortise is not necessary, and is associated with a higher risk of tibial non-union. Keywords: Distal tibia, fibula, fracture, fixation, osteosynthesis. Introduction Fractures involving the distal third tibia are common long bone fractures with an increasing incidence of road traffic accident (RTA) worldwide. It is also one of the most feared fractures because of the increased soft-tissue complications and worse prognosis in terms of fracture fixation. Distal tibia fractures with or without fibula fractures may present as tibial pilon injuries, extra-articular distalone-third tibia fractures, or exclusively ankle injuries [1]. Various options of fibula osteosynthesis have been described for ankle and tibial pilon fractures, but there is no |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6574](https://doi.org/10.13107/jocr.2025.v15.i12.6574) | Author’s Photo Gallery | | | | | | | --- | --- | --- | --- | --- | --- | --- | | |
Dr. Kishore Ragavendra Rajesh |
Dr. Sundar Suriyakumar | | | | | | |
1Department of Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Address of Correspondence:
Dr. Sundar Suriyakumar,
Department of Orthopaedic surgery, Sri Ramachandra institute of higher education and research, Plot No.1372, F1 Sharon Shelters, I Block, 28th Street, Kambar Colony, 18th Main Road, Anna Nagar West, Chennai-40, India.
E-mail: [drssundhar@gmail.com](drssundhar@gmail.com) | | | | | | | Submitted: 21/09/2025; Review: 25/10/2025; Accepted: November 202

FAQs

What question does the study investigate about fibula fixation?

It evaluates whether fibula fixation is necessary alongside internal fixation for extra-articular distal one-third tibia fractures by comparing clinico-radiological and functional outcomes between fibula fixed and not fixed groups.

How was fibula fixation evaluated in this prospective study?

Radiological assessment of coronal and sagittal malalignment, RUST scoring for tibial union, and clinical checks for rotational malalignment and post-operative infection were performed, with follow-up for at least 6 months.

What were the main findings regarding tibial healing?

Tibial union rate was better in the fibula not fixed control group than in the fibula fixed group, with statistical significance. Additional fibula fixation did not improve healing and was associated with greater morbidity, including wound infections and delayed healing.

Sep 29, 2026

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