Intramedullary pinning of concomitant fibular shaft fractures prevents postoperative tibial shaft malalignment without increasing soft tissue complications.

BACKGROUND

Tibial diaphysis fractures, accounting for 17 % of lower extremity fractures, are often associated with fibular fractures. This study compares intramedullary pinning and extramedullary plating for fibular fixation following tibial fracture fixation.

METHODS

A retrospective analysis was performed on 215 patients treated between 2012 and 2022. Patients were grouped by fibular fixation: no fixation, intramedullary pin, or extramedullary plate. Logistic regression identified risk factors for postoperative tibial malalignment and soft tissue complications.

RESULTS

Malalignment occurred in 14.9 % of patients, with higher rates in those without fibular fixation (28.6 %) versus pinning (10.8 %) or plating (7.4 %). Logistic regression showed pinning (OR = 0.263, p = 0.029) and plating (OR = 0.162, p < 0.001) reduced malalignment risk without significant differences between methods. Plate fixation increased soft tissue complications (OR = 3.955, p = 0.003), whereas pinning did not (OR = 1.924, p = 0.297).

CONCLUSION

Intramedullary pinning offers similar alignment benefits to plating without increasing soft tissue complications and may be preferable in comminuted fractures or compromised soft tissue conditions.

LEVELS OF EVIDENCE: Level III.