Spiral and oblique fractures of distal one-third of tibia-fibula: Treatment results with circular external fixator

Introduction: Spiral and oblique fractures of distal 1/3 of tibia-fibula are relatively common fractures of long bones. Due to their types, aetiology, limited coverage and blood supply, these fractures often lead to union and soft tissue problems. Materials and Methods: Twenty-seven patients with spiral and oblique fractures of distal 1/3 of tibia-fibula were treated with circular external fixator (CEF) between January 1997 and August 2000. All the fractures were closed. The type of fractures based on AO classification were A1 (n = 8), A2 (n = 6), B1 (n = 11) and C1 (n=2). Results: The mean framing time was 14.1 +/- 1.8 weeks (range, 12 to 19 weeks), and the mean treatment time was 18.8 +/- 2.2 weeks (range, 15 to 24 weeks). The patients were followed up for 36 to 78 months (mean follow-up time: 51.9 +/- 10.4 months). The results were evaluated for shortness, angulation, rotation, ankle stiffness, pain and infection. After removal of the frames, 11 patients had ankle pain and stiffness, and 3 patients had loss of range of motion in the ankle even after rehabilitation. None of the patients suffered any complications such as shortness, angulation, rotational deformity and infection, and none had loss of motion in the knee. Conclusions: CEF might be a preferable alternative treatment for distal tibia-fibula fractures due to its easy application, fewer major complications such as shortness and angulation, early mobilisation and shorter treatment time.