Distal Tibia Delayed Union with Fibular Shortening Causing Syndesmotic Instability and Anterolateral Impingement
Austin J Cantrell, Joshua A Wilson, Amgad Haleem, Seth Boydstun
Intramedullary nail, Malalignment,Distal tibia and fibula fracture
Citation Information :
Cantrell AJ, Wilson JA, Haleem A, Boydstun S. Distal Tibia Delayed Union with Fibular Shortening Causing Syndesmotic Instability and Anterolateral Impingement. 2019; 1 (1):31-34.
Debate continues in the current orthopedic literature regarding advantages of performing concurrent fibular stabilization in combined distal tibial and fibular fractures. In this case report, we present the correction of tibial malalignment, fibular fixation, and syndesmotic restoration in a 21-year-old male after a high-energy injury where he sustained a fracture of the tibia and fibula at the same level that was initially managed with tibial nailing alone. After initially having delayed union, valgus malalignment and resultant syndesmotic pain and instability following the index surgery, he underwent revision surgery resulting in favorable recovery with cessation of his pain and correction of his malalignment.
De Giacomo AF, Tornetta PIII. Alignment after intramedullary nailing of distal tibia fractures without fibula fixation. J Orthop Trauma 2016;30(10):561–567. DOI: 10.1097/bot.0000000000000637.
Egol KA, Weisz R, Hiebert R, et al. Does fibular plating improve alignment after intramedullary nailing of distal Metaphyseal tibia fractures? J Orthop Trauma 2006;20(2):94–103. DOI: 10.1016/s0276-1092(08)70090-7.
Morin PM, Reindl R, Harvey EJ, et al. Fibular fixation as an adjuvant to tibial intramedullary nailing in the treatment of combined distal third tibia and fibula fractures: a biomechanical investigation. Can J Surg 2008;51(1):45–50.
Bonnevialle P, Lafosse J-M, Pidhorz L, et al. Distal leg fractures: how critical is the fibular fracture and its fixation? Orthop Traumatol Surg Res 2010;96(6):667–673. DOI: 10.1016/j.otsr.2010.07.002.
Vaughn J, Gotha H, Cohen E, et al. Nail dynamization for delayed union and nonunion in femur and tibia fractures. Orthopedics 2016;39:e1117–e1123. DOI: 10.3928/01477447-20160819-01.
Dodd L, Jackson M, Varma R. Poller blocking screws and intramedullary nailing in tibial malunion. Ann R Coll Surg Engl 2007;89(8):816–818. DOI: 10.1308/rcsann.2007.89.8.816b.
Sengodan MM, Vaidyanathan S, Karunanandaganapathy S, et al. Distal tibial metaphyseal fractures: does blocking screw extend the indication of intramedullary nailing? ISRN Orthop 2014;2014:542623.
Krettek C, Miclau T, Schandelmaier P, et al. The mechanical effect of blocking screws (“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. J Orthop Trauma 1999;13(8):550–553. DOI: 10.1097/00005131-199911000-00006.
Krettek C, Stephan C, Schandelmaier P, et al. The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Joint Surg Br 1999;81(6): 963–968. DOI: 10.1302/0301-620x.81b6.10000.
Stedtfeld HW, Mittlmeier T, Landgraf P, et al. The logic and clinical applications of blocking screws. J Bone Joint Surg Am 2004; 86-A(Suppl 2):17–25. DOI: 10.2106/00004623-200412002-00004.
Van der Schoot DKE, Den Outer AJ, Bode PJ, et al. Degenerative changes at the knee and ankle related to malunion of tibial fractures. 15-year follow-up of 88 patients. J Bone Joint Surg 1996;78(5):722–725.
Puno RM, Vaughan JJ, Stetten ML, et al. Long-term effects of tibial angular malunion on the knee and ankle joints. J Orthop Trauma 1991;5(3):247–254. DOI: 10.1097/00005131-199109000-00001.
Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma 2005;19(2):102–108. DOI: 10.1097/00005131-200502000-00006.
Uchiyama E, Suzuki D, Kura H, et al. Distal fibular length needed for ankle stability. Foot Ankle Int 2006;27(3):185–189. DOI: 10.1177/107110070602700306.
Porter DA, Jaggers RR, Barnes AF, et al. Optimal management of ankle syndesmosis injuries. Open Access J Sports Med 2014;5:173–182. DOI: 10.2147/OAJSM.S41564.