The Role of the Fibula in Healing Closed Diaphyseal Tibial Fractures Treated with Intramedullary Interlocking Nailing

Abstract

Background: Tibial shaft fractures are common injuries, often managed with reamed intramedullary nailing due to its benefits in providing stability and promoting healing. The study aimed to compare the surgical outcomes of closed tibial shaft fractures managed with reamed intramedullary nailing in patients with either an intact or fractured fibula. Methods: A total of 130 patients with closed tibial shaft fractures treated with reamed intramedullary nailing were included in this one-year study. Patients were divided into two groups: Group A (intact fibula, n=65) and Group B (fractured fibula, n=65). Outcomes were assessed through clinical and radiographic evaluations at 6, 12, and 24 weeks postoperatively. Functional outcomes were measured using Johner and Wruh’s criteria, and radiological healing was assessed using the RUST score. Statistical analysis was performed to determine significant differences between groups. Results: The union rate at 6 months was significantly higher in Group B (fractured fibula) at 92.3% compared to 83.1% in Group A (p=0.04). Delayed union was more common in Group A (15.4%) than in Group B (7.7%), with a statistically significant difference (p=0.03). No significant difference was found in malunion or non-union rates between groups. Group B demonstrated better radiological healing with a higher mean RUST score (9.4) compared to Group A (8.6, p=0.01). Conclusion: Patients with a fractured fibula in conjunction with tibial shaft fractures show a higher union rate and faster healing than those with an intact fibula. The presence of an intact fibula may increase the risk of delayed union. Recommendations: Clinicians may consider the potential benefits of fibula fracture in enhancing tibial healing when planning treatment strategies. Further research is recommended to explore biomechanical and biological mechanisms underlying these outcomes.

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