Should We Pay Attention to the Fibular Segmental Fracture in the Management of Leg Fractures?

Fibular fractures are the most common associated fractures with tibia injuries. The current study aimed at collecting data on segmental fibular fractures in the patients and investigating the prognostic and functional significance of this injury pattern in outcomes.
The charts were retrospectively reviewed from 2013 to 2016 to find patients with segmental fibular fractures. Patients’ history, physical examinations, initial radiographic findings, surgical reports, and follow-up data were evaluated. The patients were also assessed for union status, infection, limb shortening, and complications. Fractures were defined as segmental when the bone was disrupted in 2 points and a segment of bone with circumferential cortices was apart from the main bone proximally and distally.
During the 3-year period of the current study, out of 212 patients with leg fracture (tibiofibular fracture) treated in Imam Khomeini hospital, 17 patients (8%) had segmental fibular fractures. In the observed fibular fractures, the number of fracture fragments was between 3 and 6 segments. After 6 months, the rate of union was 70% in the tibia and 88% in the fibula. Overall, 6 patients needed re-operation, 1 of them had below knee amputation, and 5 other had surgeries because of tibial nonunion.
The current study results showed that presence of a segmental fibular fracture may be associated with higher rates of complications. Fixation of the fibula in this situation can lead to nonunion. However, more studies are needed to approve or reject this conclusion.