Tibial shaft fractures with intact fibula – trauma mechanisms and associated injuries

The diagnostics and treatment of tibial shaft fractures with an intact fibula remains controversial due to the possibility of the intact fibula negative effect on tibial fracture consolidation. The aim of the study is to evaluate the trauma mechanism and diagnostics of tibial shaft fractures with intact fibula. A retrospective study of 19 patients with tibial shaft fractures with an intact fibula admitted to the Hospital of Traumatology and Orthopaedics from 2013 till 2017 was conducted. Eighteen patients were treated by tibial internal fixation using intramedullary nailing and one patient had open reduction and internal fixation with plate. Trauma mechanisms, preoperative, postoperative and follow-up radiographs were analysed. There were 19 patients with fractures of the tibia and intact fibula (13 male, 6 female, age 19-91 years). Trauma mechanisms were motorcycle accidents (5 patients), skiing (3 patients), ice hockey training (2 patients), football training (1 patient), fall down the stairs (1 patient), fall on the street (6 patients), fall in to a pit (1 patient). There were seven A1, four A2, five A3 type; one B3 type and two C3 type fractures. Patients had 10 associated injuries: one marginal talus fracture, one medial malleolus fracture, two fractures of the medial malleolus apex, two avulsion fractures of lateral malleolus apex, two deltoid Līgament injuries, one Volkmann`s triangle fracture, one fibular head fracture. In the two years follow-up radiological examination two patients had shortened tibia and varus malunion of tibia; four patients had deformed fibula.The mean time to complete healing of these fractures was 22 weeks (range: 19-24 weeks). Our findings suggest that two thirds of patients with tibial shaft fractures with intact fibula suffer from motorcycle and sports injuries. Careful clinical and radiological evaluation of lower leg is essential to diagnose associated injuries.