The Journal of Bone and Joint Surgery, Vol 62, Issue 5 770-776, Copyright © 1980 by Journal of Bone and Joint Surgery, Inc
Problems associated with tibial fractures with intact fibulae
CC Teitz, DR Carter and VH Frankel
Of twenty-three patients more than twenty years old who were treated for a
tibial shaft fracture without a concomitant fibular fracture, six (26 per
cent) had delayed union or non-union and six (26 per cent) had varus
malunion of the fractured tibia. Pain and roentgenographic changes
developed in the ipsilateral ankle within two years of injury in two of
these six patients with malunion. Of forty-five patients less than twenty
years old with similar fractures, one had delayed union and twelve (27 per
cent) had varus malunion. Pain in the ipsilateral ankle was observed in two
of these twelve patients with malunion. In addition, a bent fibula was
observed in thirteen patients who incurred their fractures when they were
less than twenty but in no patients who were more than twenty years old at
the time of fracture. Clinical observations were corroborated by
biomechanical studies on an experimental model. These studies suggested
that when the fibula remains intact, a tibiofibular length discrepancy
develops and causes altered strain patterns in the tibia and fibula. These
may lead to delayed union, non-union, or malunion of the tibia with the
sequelae of joint disturbances. The lower incidence of complications in
patients less than twenty years old may be due to the greater compliance of
their fibulae and soft tissues.
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