Journal of Musculoskeletal Trauma

Comparison of the Results between Plating and Intramedullary Nailing for Ipsilateral Fibular Fractures in Pilon Fractures: Yong Jin Cho, Jun Young Lee, Jae Hwan Lim, Je Hong Ryu, Jung Ho Lee; J Korean Fract Soc 2021;34(3):97-104. Published online July 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.3.97

Abstract PDF: Purpose
To compare the results between plating and intramedullary nailing for ipsilateral fibular fractures in pilon fractures.
Materials and Methods
Among 124 patients with pilon fractures from November 2008 to March 2019, 50 patients with a fibular fracture were studied retrospectively and divided into two groups: Group A using a plate and Group B using a Rush pin. The radiological tests confirmed the fracture pat-terns (Rüedi–Allgöwer classification, AO/OTA classification) and evaluated the degree of reduction of fibular and tibial fractures after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) was examined for a clinical evaluation, and the complications were checked.
Results
The two groups showed similar distributions in gender, age, injury mechanism, diabetes, smoking, mean follow-up period, Rüedi–Allgöwer classification, AO/OTA classification, and open fracture. The fibular fractures were classified as simple, wedge, multiple, and segmental, showing significant differences between the two groups (p=0.03). There was no difference in the Talocrural angle, Shenton line, and Dime sign. In the reduction of pilon fractures, the appropriate reduction was obtained in 22 cases (88.0%) for both groups. The AOFAS averaged 83.24 in Group A and 80.44 points in Group B, showing no significant difference in complications (nonunion, malunion, infection, and arthritis).
Conclusion
Regardless of how the fibular fracture was fixed, the reduction of pilon fractures in both groups showed good results. Both intramedullary nail and plate fixation could be a suitable fixation method for ipsilateral fibular fractures with a low risk of shortening in pilon fractures.

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Analysis of Risk Factors for the Posterolateral Articular Depression and Status of Posterolateral Fragment in Lateral Condylar and Bicondylar Tibial Plateau Fractures with Joint Depression: Jung Yun Choi, Yong Woon Shin, Beom Jung Lee; J Korean Fract Soc 2013;26(4):241-247. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.241

PURPOSE
To evaluate risk factors of posterolateral articular depression and characteristics of the posterolateral fragment in lateral condylar and bicondylar tibial plateau fractures with joint depression.
MATERIALS AND METHODS
We reviewed 48 patients of Schatzker type II and type V (type II 34, type V 14) and evaluated risk factors of posterolateral articular depression according to the posterolateral fragment, fibular fracture, and Schatzker classification. We evaluated the position of articular depression and anterolateral fracture line of the posterolateral fragment and measured anterior to posterior lengths of the posterolateral fragment.
RESULTS
Posterolateral articular depression was found in 20 of 34 cases (59%) with coexisting posterolateral fragment and in 16 of 21 cases (76%) with coexisting fibular fracture. There was a significant difference in the occurrence of posterolateral articular depression with the existence of the posterolateral fragment and fibular fracture (p<0.001). Multivariate regression analysis revealed that fibular fracture increased the occurrence of posterolateral articular depression (odds ratio 24.5, 95% confidence interval 2.2-267.2). Fifty-seven percentage of the anterolateral fracture line of the posterolateral fragment existed posterior to the anterior margin of the fibular head.
CONCLUSION
This study showed that fibular fracture affects posterolateral articular depression in Schatzker type II and V tibial plateau fractures. Selecting a fixation device and performing fracture reduction requires a careful consideration since the anterolateral fracture line of the posterolateral fragment exists posterior to the anterior margin of the fibular head.

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Current Concepts in Management of Tibia Plateau Fracture
Sang Hak Lee, Kang-Il Kim
Journal of the Korean Fracture Society.2014; 27(3): 245. CrossRef

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Extensive Metallosis Caused by Plate and Screw Construct for Distal Fibular Fracture - A Case Report -: Ki Tae Park, Kwang Bok Lee; J Korean Fract Soc 2013;26(2):147-150. Published online April 30, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.2.147

Abstract PDF

Metallosis has been reported in the setting of weight-bearing joint arthroplasties, like the hip and knee joints. However, the prevalence of metallosis in non-articular portions is very uncommon. We report a rare case of a patient who had metallosis secondary by fibular nonunion after fixation with plate and screw. In addition, we discuss the clinical and the operative findings, as well as the outcome of this uncommon complication.

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Plate on Plate Osteosynthesis for the Treatment of Nonhealed Periplate Fractures
Georgios Arealis, Vassilios S. Nikolaou, Andrew Lacon, Neil Ashwood, Mark Hamlet
ISRN Orthopedics.2014; 2014: 1. CrossRef

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Posterior Plating in Distal Fibular Fracture: Choong Hyeok Choi, Young A Cho, Jae Hoon Kim, Il Hoon Sung; J Korean Fract Soc 2007;20(2):161-165. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.161

Abstract PDF

PURPOSE
To report the technical experience of posterior plating for the distal fibular fracture.
MATERIALS AND METHODS
20 Weber type-B fibular fractures were included in this study, which were treated with the posterior plating. 1/3 semitubular plate was used and orientation of all screws were intended to be perpendicular to the plate as possible. Fixation stability and maintenance of reduction after plating was assessed manually in the operating field. Clinical results were evaluated at least 1 year after operation, using American Orthopaedic Foot and Ankle Society (AFOAS) Ankle-Hindfoot score.
RESULTS
5 cases were firmly stabilized without using any lag screw or fixation of distal fragment. For improving stability or achieving proper reduction, a lag screw was placed posteroanteriorly through the plate in 14 cases. Anteroposterior interfragmentary fixation in 1 case before plating, and contouring of the plate in 3 cases were needed in cases of which the posterior plating impeded reduction of distal fibular fracture. In all cases, fracture was stabilized without fixation through the most distal hole. There were no major postoperative complications. AFOAS score was 95.5Â±5.2.
CONCLUSION
The posterior plating technique for distal fibular fracture is regarded as a recommendable option. Additional fixation with interfragmentary screw or contouring of the plate, however, would be needed in some cases to achieve anatomical reduction or sufficient stability.

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A Specialized Fibular Locking Plate for Lateral Malleolar Fractures
Eui Dong Yeo, Hak Jun Kim, Woo In Cho, Young Koo Lee
The Journal of Foot and Ankle Surgery.2015; 54(6): 1067. CrossRef

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Result of Fibular Fixation Using Screw in Ankle Fracture: Chung Soo Han, Yang Sun Im, Sun Teak Cheong; J Korean Soc Fract 2002;15(4):477-482. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.477

Abstract PDF

PURPOSE
To compare the use of screw only fixation with lateral one-third tubular plate fixation of non-comminuted oblique fracture of the lateral malleous and report the advantages of screw only fixation MATERIALS AND METHODS: From January 1996 to January 2000, we had operated 44 cases of non-comminuted oblique fractures of the lateral malleous (Denis-Weber type B, Lange-Hausen classification supination-external rotation injury). All cases had a follow-up period of over 6 months. There were 21 cases of cortical or bone screw fixation (group I) and 23 cases of one third tubular plate fixation (group II). Radiologic and clinical outcome parameters were used to compare group I with group II.
RESULTS
There were no significant difference in bone union rate and period between group I and group II (group I : 92 days, group II : 89 days). All cases of both groups recovered a complete range of motion after cast off. There was 1 case superficial infection in group II.
CONCLUSION
The radiologic and clinical results and complications between screw only fixation and one-third tubular plate fixation at non-comminuted lateral fibular fracture have no difference. The advantage of screw only fixation at non-comminuted lateral malleolar fracture is a small incision, short operation time and decreased patient 's complaints as compared with a similar group of patients treated by fixation with a lateral one third tubular plate fixaiton.

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A Rehabilitation for Ankle Fracture in Korean Medicine: A Report of 4 Cases
Won-Bae Ha, Jong-Ha Lee, Yoon-Seung Lee, Dong-Chan Jo, Jin-Hyun Lee, Jung-Han Lee
Journal of Korean Medicine Rehabilitation.2017; 27(4): 171. CrossRef

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The effects of the fibular stabilization in the treatment of distal tibio-fibula fracture: Kyung Jin Song, Gyu Hyung Kim, Myung Sik Park, Byung Yun Hwang; J Korean Soc Fract 2001;14(4):660-667. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.660

Abstract PDF: PURPOSE
The purpose of this study was to analyze the effect of fibula stabilization on reduction and union time of tibial fracture, and change in ankle mortise in the treatment of distal tibiofibular fracture.
MATERIALS AND METHODS
We reviewed 23 cases with distal tibiofibula fracture; 10 cases were stabilized and 13 cases were not stabilized for the fibula fracture with reduction and stabilization for the tibia fracture. We analyzed the initial and last follow-up radiograph, and clinical functional outcome.
RESULTS
There were significant differences in the tibiofibular clear space and tibiofibular overlap between two groups and there were somewhat significant differences in the union time of the tibial fracture and ROM of ankle and pain of fracture site or ankle between two groups. But there were no significant differences in talo-crural angle and gap of tibial fracture site between two groups. Moreover, such factors as initial displacement, soft tissue damage, comminution of fracture were affected the union time and prognosis of a tibial fractures.
CONCLUSION
Fibular stabilization group was effective in the maintenance of ankle mortise but there was no difference in the functional outcome. Analysis for much more cases and long term follow-up will be necessary for the precise evaluation of the treatment results.

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The Effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail: Ki Soo Kim, Yong Soo Choi, Jong Jun Park, Sun Young Chung; J Korean Soc Fract 1996;9(2):449-457. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.449

Abstract PDF: The effect of fibular fractures in the healing of tibial shaft fractures has controversial results. Its results are the greater part of the data for the conservative treatment of tibial shaft fractures. Recently closed interlocking nailing has been the most efficient treatment for displaced fractures of the tibial shaft. The purpose of this study was to evaluate the effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail and to determine whether the fibular fracture had a relation with other prognostic factors. From Mar. 1992 to Feb. 1995. the authors performed interlocking nailing for displaced fractures of the tibial shaft in 111 patients. We reviewed 98 patients with a minimal ten month follow up period. We divided the fractures into three groups; the intact fibula group which consisted of 15 patients had tibial shaft fractures with intact fibula, the same level fracture group had tibiofibular fractures at the same level in 56 patients and the different level fracture group had tibiofibular at different level in 27 patients. The results were as follows: 1. Clinically excellent and good results, according to Klemm and Horner criteria. were in 15 patients(100%) of the intact fibula group,49 patients(87.4%) in the same level fracture group and 21 patients(92.5%) in the different leyel fracture group. 2. Radiologically bone healing was obtained in 15 patients(100%) with a mean union time of 13.3 weeks in the intact fibula group, 42 patients(75.O%) with a mean union time of 17.9 weekf in the same level fracture goup and 2,1 patients(85.2%) with a mean union time of 15.3 weeks in the different level fracture group. 3. The same level fracture group had a tendency to cause a bending force while the different level fracture group tended to treat a torsional force. We found that the bending fractures had the worst prognosis. These results suggest that the treatment of tibial shaft fractures with an intact fibula by using an interlocking nail prevents significant complications and allows early weight bearing, thus permiiting early mobilization of the traumatized patient. The level of the fibular fracture associated with the tibial fracture may be a useful prognostic factors in the healing of tibial shaft fractures.

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The effects of the flbular stabilization in the treatment of tibio-fibula shaft fracture: Dong Bae Shin, Young Kyu Lee, Jang Yeob Ahn, Byung Kuk Cho, Dae Ug Hur; J Korean Soc Fract 1994;7(2):634-641. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.634

Abstract PDF: Many authors have been discussed effects of fibular stabilization in the healing of the tibiofibular shaft fracture. A-0 group recommand fixation of the fibular shaft fracture in treatment of tibio-fibula shaft fracture with rationale of more stability of tibial fracture site and anatomical restoration of tibio-fibula relationship and so better effect on ankle motion. The purpose of this study is to indentify the effect of fibula stabilazation on reduction state of tibial fracture site, change in ankle mortise and healing period of tibial fracture site. Authors performed fibula stabilization with 1/3 plate and screws in 8 cases of tibio-fibula shaft fracture and compare with 40 cases of tibio-fibula fracture without fibula stabilization in point of above mentioned three effects. The results were as follows. 1. O/R & I/F of the fibular fracture, had no effect on the reduction state of the tibial shaft fracture site but it was somewhat helpful to restoration of the ankle mortise owing to the restoration of the fibular length. 2. There were no significant differences in the weight bearing time and the union time of the tibial fracture between two groups. 3. We experienced 2 cases of implant failure on the fibular fixation site, due to shortening of the tibial fracture site and overloading of the fibular fixation site. In these 2 cases, ankle pain was debeloped before the implant-failure. From the above result, we suggest that fibula stabilization have no benefit in treatment of tibio-fibular shaft fracture.

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