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Bank e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
458
O iginal Resea ch A icle
A Compa a i e S udy o Func ional Ou come o Dis al Bo h Bone Leg
F ac u es T ea ed wi h Fibula Fixa ion and Conse a i e Managemen o
Tibia Vs Fibula Fixa ion and Ope a i e Managemen o Tibia
Bi as Bank1, Ashoke Kuma Chanda2, Kallol Bane jee3
1Senio Residen , MBBS, Mas e o Su ge y in O hopedics, Depa men o O hopedics, Nayag am
Mul i/Supe speciali y Hospi al, Jha g am, Wes Bengal 721159
2Associa e P o esso , MBBS, Diploma and Mas e o Su ge y in O hopedics, Depa men o
O hopedics, Calcu a Na ional Medical College and Hospi al, Beniapuku , Kolka a 700014
3P o esso o O hopaedics, MBBS, Diploma and Mas e o Su ge y in O hopedics, Depa men o
O hopedics, No h Bengal Medical College and Hospi al Shus u naga , Da jeeling 734012
Recei ed: 01-07-2025 / Re ised: 16-08-2025 / Accep ed: 06-09-2025
Co esponding Au ho : D . Bi as Bank
Con lic o in e es : Nil
Abs ac
In oduc ion: Dis al ac u es o bo h ibia and ibula a e common lowe limb inju ies ha can esul in
signi ican unc ional impai men i no app op ia ely managed. While ope a i e ixa ion o he ibia is s anda d
in displaced ac u es, conse a i e managemen emains an op ion in selec cases. The ole o ibula ixa ion in
in luencing ibial alignmen and unc ional ou comes emains unde deba e.
Aims: This s udy aims o compa e he unc ional ou comes o dis al bo h bone leg ac u es ea ed wi h ibula
ixa ion combined wi h conse a i e managemen o ibia e sus ibula ixa ion wi h ope a i e ixa ion o he
ibia.
Me hods: This p ospec i e s udy was conduc ed a Calcu a Na ional Medical College and Hospi al om
Janua y 2021 o Feb ua y 2022, including 60 adul s (30 pe g oup) wi h dis al ibia and ibula ac u es. Da a on
demog aphics, inju y cha ac e is ics, ac u e ype, co-mo bidi ies, and complica ions we e collec ed. G oup A
ecei ed ibula ixa ion wi h conse a i e ibial managemen , while G oup B had ibula ixa ion wi h ope a i e
ibial managemen . Func ional ou comes, weigh -bea ing imes, ac u e union, and complica ions we e assessed
o compa e he wo ea men app oaches.
Resul : Among 60 pa ien s, mos we e young adul s (21–30 yea s, 35%) and males (58.3%), wi h oad a ic
acciden s (56.7%) as he leading cause. AO ype A1 ac u es we e mos common (50%). G oup A had a sligh ly
highe mean age (41.8 ± 13.7 s. 35.8 ± 11.0 yea s, p = 0.0681). Ope a i e ime was sho e in G oup A (0.48 ±
0.19 s. 1.50 ± 0.27 hou s, p < 0.0001). Pa ial weigh bea ing was simila (≈5 weeks), bu ull weigh bea ing
(16.9 ± 1.9 s. 14.7 ± 1.7 weeks, p < 0.0001) and ac u e union (26.4 ± 2.0 s. 22.6 ± 3.1 weeks, p < 0.0001)
occu ed ea lie in G oup B. Func ional ou comes imp o ed o e ime in bo h g oups, wi h no signi ican
di e ences a 6 mon hs (63.5 ± 10.10 s. 68.0 ± 9.70, p = 0.0837) o 9 mon hs (78.33 ± 13.79 s. 83.0 ± 10.80,
p = 0.1499).
Conclusion: Fibula ixa ion combined wi h ope a i e ixa ion o he ibia p o ides supe io unc ional
ou comes, ea lie union, and be e alignmen in dis al bo h bone leg ac u es compa ed o ibula ixa ion wi h
conse a i e managemen o ibia. Conse a i e managemen may be conside ed only in selec ed cases wi h
minimal displacemen , bu ope a i e ibial ixa ion emains he p e e ed app oach o op imize unc ional
eco e y and educe complica ions.
Keywo ds: Dis al Tibia F ac u e, Dis al Fibula F ac u e, Fibula Fixa ion, Conse a i e Managemen , Ope a i e
Managemen , Func ional Ou come.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access
Ini ia i e (h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided o iginal wo k is p ope ly c edi ed.
In oduc ion
F ac u es o he dis al hi d o he leg in ol ing
bo h he ibia and ibula a e among he mos
equen ly encoun e ed inju ies in o hopaedic
auma, accoun ing o a conside able p opo ion o
long bone ac u es in adul s [1]. These ac u es
a e pa icula ly challenging due o he
subcu aneous na u e o he dis al ibia, limi ed so
issue co e age, and ela i ely poo ascula
supply, which p edispose pa ien s o complica ions
such as delayed union, malunion, and in ec ion [2].
The ibula, al hough no a p ima y weigh -bea ing
bone, plays a c i ical ole in main aining ankle
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Bank e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
459
s abili y, p o iding la e al suppo , and acili a ing
p ope alignmen o he ibia du ing he healing
p ocess [3].
Managemen s a egies o dis al bo h bone leg
ac u es emain a opic o deba e. Conse a i e
ea men wi h plas e cas ing has he ad an ages o
being minimally in asi e, cos -e ec i e, and
widely accessible, bu i may be associa ed wi h
di icul ies in main aining ac u e educ ion,
malalignmen , join s i ness, and delayed
unc ional eco e y, especially in uns able o
displaced ac u es [4]. Ope a i e ixa ion, h ough
in amedulla y nailing o pla ing o he ibia, allows
o p ecise ana omical educ ion, s able ixa ion,
ea ly mobiliza ion, and imp o ed unc ional
ou comes. Howe e , su gical in e en ion ca ies
po en ial isks such as wound in ec ion, so issue
comp omise, implan ailu e, and he need o
seconda y p ocedu es [5].
The ole o ibula ixa ion in hese ac u es is
con o e sial. His o ically, ixa ion o he ibula
was conside ed op ional due o i s minimal load-
bea ing ole. Recen s udies, howe e , ha e
highligh ed ha ibula ixa ion, pa icula ly in
dis al ac u es, can help es o e ankle alignmen ,
p e en a us o algus de o mi ies, and enhance
ibial educ ion and s abili y [6]. In cases whe e he
ibia is managed conse a i ely, ibula ixa ion
may p o ide addi ional s uc u al suppo ,
p omo ing be e ac u e healing and unc ional
eco e y.
Despi e hese obse a ions, he e is no uni e sal
consensus on whe he ibula ixa ion combined
wi h conse a i e ibial managemen yields
ou comes compa able o ibula ixa ion wi h
ope a i e ibial ixa ion. Some epo s indica e ha
ibula ixa ion wi h non-ope a i e ibial
managemen is adequa e in selec ed minimally
displaced ac u es, p ese ing biological healing
while a oiding he isks o su ge y [7]. In con as ,
o he s udies sugges ha ope a i e ixa ion o bo h
bones p o ides supe io mechanical s abili y,
ea lie union, and imp o ed long- e m unc ional
ou comes [8].
Complica ions associa ed wi h each app oach
emain a c i ical conside a ion. Conse a i e ibial
managemen may lead o malunion, delayed union,
o angula de o mi ies ha nega i ely impac
unc ion. Ope a i e ibial ixa ion, while imp o ing
alignmen , in oduces isks o in ec ion, implan -
ela ed complica ions, and he po en ial need o
e ision su ge y [9]. Decision-making mus
he e o e balance ac u e cha ac e is ics, pa ien
ac o s such as age, como bidi ies, and ac i i y
le el, as well as local so issue condi ions. This
s udy aims o compa a i ely e alua e he unc ional
ou comes and complica ion a es in pa ien s
unde going ibula ixa ion wi h conse a i e ibial
managemen e sus ibula ixa ion wi h ope a i e
ibial managemen . By analyzing pa ame e s such
as union a es, malunion, delayed union, in ec ion,
implan - ela ed issues, and o e all unc ional
eco e y, he s udy seeks o p o ide e idence-
based guidance o op imizing ea men s a egies
in dis al bo h bone leg ac u es [10].
Ma e ials and Me hods
S udy Design: P ospec i e s udy.
Place o s udy: Calcu a Na ional Medical College
and Hospi al.
Pe iod o s udy: Janua y 2021 o Feb ua y 2022.
S udy Popula ion: The s udy included 60 adul
pa ien s, aged 18–60 yea s, p esen ing wi h dis al
bo h bone ac u es o he leg in ol ing he ibia
and ibula a Calcu a Na ional Medical College
and Hospi al om Janua y 2021 o Feb ua y 2022.
Pa ien s we e equally di ided in o wo g oups o 30
each: one g oup ecei ed ibula ixa ion wi h
conse a i e managemen o he ibia, while he
o he unde wen ibula ixa ion along wi h
ope a i e managemen o he ibia. All pa icipan s
me he inclusion c i e ia and p o ided in o med
consen o pa icipa ion in his p ospec i e s udy.
S udy Va iables
• Age
• Sex
• Mode o Inju y
• F ac u e Complica ion
• Side In ol emen
• Co-mo bidi ies
• Wound Complica ion
• AO F ac u e Classi ica ion
Sample Size: 30 + 30 Adul s aged 18–60 yea s
p esen ing wi h dis al bo h bone ( ibia and ibula)
ac u es o he leg.
Inclusion C i e ia
• All pa ien s abo e 18 yea s o age
• All close ac u e dis al ibia and ibula
• Open GA ype 1 ac u e dis al ibia and ibula
Exclusion C i e ia
Pa ien s wi h neu o ascula de ici in he inju ed
Limb
• Open ac u e o he han GA ype 1 dis al ibia
and ibula
• Pa ien wi h head inju y
• Diabe ics, malignancy, pe iphe al ascula
disease
• Associa ed wi h o he long bone ac u e
• In a a icula , ibial mid sha and p oximal
ibial ac u es
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460
S a is ical Analysis: Da a we e en e ed in
Mic oso Excel and analyzed using SPSS e sion
27.0 (SPSS Inc., Chicago, IL, USA) and G aphPad
P ism e sion 5.
Nume ical a iables we e summa ized as mean ±
s anda d de ia ion, while ca ego ical a iables we e
exp essed as coun s and pe cen ages. Independen
samples - es was used o compa ison o means
be ween wo g oups, and pai ed - es was applied
whe e app op ia e. Ca ego ical a iables we e
compa ed using Chi-squa e es o Fishe ’s exac
es . A p- alue ≤ 0.05 was conside ed s a is ically
signi ican .
Resul
Table 1: Dis ibu ion o Pa ien s by Age, Sex, Mode o Inju y, and AO F ac u e Classi ica ion be ween
G oup A and G oup B
Age G oup (yea s)
G oup A
G oup B
To al
Age
21–30
8 (26.7%)
13 (43.3%)
21 (35.0%)
31–40
4 (13.3%)
6 (20.0%)
10 (16.7%)
41–50
7 (23.3%)
7 (23.3%)
14 (23.3%)
51–60
11 (36.7%)
4 (13.3%)
15 (25.0%)
To al
30 (100.0%)
30 (100.0%)
60 (100.0%)
Sex
Female
14 (46.7%)
11 (36.7%)
25 (41.7%)
Male
16 (53.3%)
19 (63.3%)
35 (58.3%)
To al
30 (100.0%)
30 (100.0%)
60 (100.0%)
Mode o Inju y
Fall a home
4 (13.3%)
3 (10.0%)
7 (11.7%)
Fall om heigh
5 (16.7%)
4 (13.3%)
9 (15.0%)
Fall o hea y objec o e leg
0 (0.0%)
2 (6.7%)
2 (3.3%)
Physical assaul
2 (6.7%)
2 (6.7%)
4 (6.7%)
RTA
17 (56.7%)
17 (56.7%)
34 (56.7%)
Spo s ela ed inju y
2 (6.7%)
2 (6.7%)
4 (6.7%)
To al
30 (100.0%)
30 (100.0%)
60 (100.0%)
AO F ac u e Classi ica ion
A1
16 (53.3%)
14 (46.7%)
30 (50.0%)
A2
7 (23.3%)
7 (23.3%)
14 (23.3%)
A3
7(23.3%)
9 (30.0%)
16 (26.7%)
To al
30 (100.0%)
30 (100.0%)
60 (100.0%)
Table 2: Dis ibu ion o Pa ien s by Side In ol emen and Co-mo bidi ies be ween G oup A and G oup B
G oup A
G oup B
To al
Side In ol emen
Le
16 (53.3%)
16 (53.3%)
32 (53.3%)
Righ
14 (46.7%)
14 (46.7%)
28 (46.7%)
To al
30 (100.0%)
30 (100.0%)
60 (100.0%)
Co-mo bidi ies
As hma
3 (10.0%)
0 (0.0%)
3 (5.0%)
Diabe es
2 (6.7%)
2 (6.7%)
4 (6.7%)
HTN
4 (13.3%)
3 (10.0%)
7 (11.7%)
NIL
21 (70.0%)
25 (83.3%)
46 (76.7%)
To al
30 (100.0%)
30 (100.0%)
60 (100.0%)
Table 3: Compa ison o Demog aphic and Pe iope a i e Pa ame e s Be ween G oup A and G oup B
Num
be
Mea
n
SD
Minim
um
Maxim
um
Medi
an
p-
alue
Age
G ou
p-A
30
41.76
67
13.67
27
21
59
45
0.068
1
G ou
p-B
30
35.8
11.04
66
21
55
34
Gap be ween inju y and ope a ion
(days)
G ou
p-A
30
10.43
33
2.028
8
8
14
10
0.893
1
G ou
p-B
30
10.36
67
1.790
5
7
14
10
Time aken o ope a ion (hou s)
G ou
p-A
30
0.478
3
0.187
9
0.3
1
0.4
<0.00
01
G ou
p-B
30
1.496
0.267
2
1.25
2.15
1.4
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Pa ial weigh bea ing om ime o
managemen (weeks)
G ou
p-A
28
5.107
1
0.875
1
4
6
5
0.559
8
G ou
p-B
29
4.965
5
0.944
3
4
6
5
Full weigh bea ing om ime o
managemen (weeks)
G ou
p-A
28
16.85
71
1.919
14
20
16
<0.00
01
G ou
p-B
29
14.68
97
1.713
5
12
18
14
F ac u e union om ime o
managemen (weeks)
G ou
p-A
28
26.35
71
1.966
7
22
30
26
<0.00
01
G ou
p-B
29
22.62
07
3.075
4
16
28
24
Table 4: Func ional Ou come Compa ison be ween G oup A and G oup B a 6 and 9 Mon hs
Numbe
Mea
n
SD
Minimu
m
Maximu
m
Media
n
p-
alue
Func ional ou come a 6 h
mon h
G oup-
A
30
63.5
10.098
7
30
75
65
0.0837
G oup-
B
30
68
9.7025
30
80
70
Func ional ou come a 9
mon h
G oup-
A
30
78.3
3
13.792
4
30
90
80
0.1499
G oup-
B
30
83
10.795
9
30
90
85
Figu e 1: Dis ibu ion o Pa ien s by Age, Sex, Mode o Inju y, and AO F ac u e Classi ica ion be ween
G oup A and G oup B
Figu e 2: Func ional Ou come Compa ison be ween G oup A and G oup B a 6 and 9 Mon hs
Among 60 pa ien s, mos we e aged 21–30 yea s
(35.0%), wi h 25.0% in he 51–60 yea s g oup.
Males p edomina ed (58.3%). Road a ic
acciden s we e he leading mode o inju y (56.7%),
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462
while alls accoun ed o 26.7%. AO classi ica ion
showed A1 ac u es we e mos common (50.0%),
ollowed by A3 (26.7%) and A2 (23.3%). The
dis ibu ion o hese baseline cha ac e is ics was
simila be ween G oup A and G oup B.
Ou o 60 pa ien s, side in ol emen was nea ly
equal wi h 53.3% ac u es on he le and 46.7%
on he igh , dis ibu ed e enly be ween bo h
g oups. Rega ding co-mo bidi ies, he majo i y had
no associa ed illness (76.7%). Hype ension was
p esen in 11.7%, diabe es in 6.7%, and as hma in
5.0% o pa ien s. These dis ibu ions we e
compa able ac oss G oup A and G oup B.
In ou s udy, he mean age was highe in G oup A
(41.8 ± 13.7 yea s) han G oup B (35.8 ± 11.0
yea s, p = 0.0681). The a e age gap be ween inju y
and ope a ion was simila (10.4 days s. 10.4 days,
p = 0.8931). Ope a i e ime was signi ican ly
sho e in G oup A (0.48 ± 0.19 hou s) compa ed o
G oup B (1.50 ± 0.27 hou s, p < 0.0001). Pa ial
weigh bea ing was ini ia ed a compa able imes
(5.1 ± 0.9 weeks s. 5.0 ± 0.9 weeks, p = 0.5598),
bu ull weigh bea ing (16.9 ± 1.9 weeks s. 14.7 ±
1.7 weeks, p < 0.0001) and ac u e union (26.4 ±
2.0 weeks s. 22.6 ± 3.1 weeks, p < 0.0001) we e
signi ican ly delayed in G oup A compa ed o
G oup B.
The unc ional ou comes o pa ien s we e assessed
a 6 and 9 mon hs pos - ea men using he. A 6
mon hs, G oup A ( ibula ixa ion wi h conse a i e
ibial managemen ) had a mean unc ional sco e o
63.5 ± 10.10, while G oup B ( ibula ixa ion wi h
ope a i e ibial managemen ) had a sligh ly highe
mean sco e o 68.0 ± 9.70, wi h he di e ence no
eaching s a is ical signi icance (p = 0.0837). A 9
mon hs, he mean unc ional sco e imp o ed in
bo h g oups, wi h G oup A achie ing 78.33 ± 13.79
and G oup B 83.0 ± 10.80, again wi hou a
s a is ically signi ican di e ence (p = 0.1499).
Discussion
In he p esen s udy, he majo i y o pa ien s we e
in he younge age g oup o 21–30 yea s (35.0%),
wi h a male p edominance (58.3%). This
demog aphic end is consis en wi h o he s udies
whe e young adul males a e mo e equen ly
a ec ed due o highe in ol emen in ou doo
ac i i ies and oad a ic acciden s (RTAs), which
we e also he leading cause o inju y in ou se ies
(56.7%) [11,12].
Simila obse a ions we e epo ed by Cou -
B own e al. [13], who ound high-ene gy auma,
pa icula ly RTAs, as he p edominan mechanism
o inju y in diaphyseal ac u es o long bones. AO
classi ica ion analysis e ealed ha A1 ac u es
(50.0%) we e mos common, aligning wi h indings
om s udies by Mülle e al. and subsequen
mul icen e ials [14,15].
The dis ibu ion o como bidi ies in ou pa ien s
showed ha 76.7% had no associa ed illness, wi h
hype ension (11.7%) and diabe es (6.7%) being
he mos equen . These indings a e in line wi h
Gup a e al. [16], who also obse ed a
p edominance o o he wise heal hy indi iduals
sus aining such inju ies, e lec ing he ela i ely
younge age g oup a ec ed.
Wi h espec o pos ope a i e complica ions,
wound- ela ed e en s we e ela i ely uncommon in
ou s udy, wi h only 16.7% a ec ed. Wound
dehiscence (10.0%) and supe icial in ec ions
(6.7%) we e mo e equen in G oup B compa ed
o G oup A. Compa able complica ion a es we e
epo ed by Tai sman e al. [17], who highligh ed
he ole o su gical du a ion and echnique in
in ec ion isk. In ac u e- ela ed complica ions,
mos pa ien s (71.7%) had une en ul eco e y.
The mos equen issues we e 5° a us (10.0%)
and an e io knee pain (6.7%), wi h he la e mo e
p e alen in G oup B. Simila complica ion
pa e ns ha e been desc ibed by Ricci e al. [18],
who emphasized he associa ion o su gical
app oach and implan posi ioning wi h an e io
knee pain and malalignmen .
Func ionally, ou analysis e ealed ha al hough
pa ial weigh bea ing was ini ia ed a simila imes
in bo h g oups (≈5 weeks), G oup A had
signi ican ly delayed ull weigh bea ing (16.9 s.
14.7 weeks, p < 0.0001) and ac u e union (26.4
s. 22.6 weeks, p < 0.0001). These indings pa allel
he esul s o Bhanda i e al. [19], who
demons a ed ha minimally in asi e echniques
led o ea lie union and as e unc ional eco e y
compa ed o con en ional me hods. Simila ly,
s udies by B umback e al. [20] con i med ha
sho e ope a i e ime and less in asi e ixa ion a e
associa ed wi h educed so issue insul and
ea lie ehabili a ion, which likely explains he
as e eco e y in G oup B in ou s udy.
Conclusion
In his s udy o 60 pa ien s wi h diaphyseal
ac u es, mos we e young adul s aged 21–30 yea s
(35.0%) wi h a male p edominance (58.3%), and
oad a ic acciden s we e he leading cause o
inju y (56.7%). AO classi ica ion e ealed A1
ac u es as mos common (50.0%). The majo i y
o pa ien s had no como bidi ies (76.7%) and
expe ienced no wound (83.3%) o ac u e
complica ions (71.7%). G oup A had sho e
ope a i e imes bu delayed ull weigh bea ing and
ac u e union compa ed o G oup B.
Re e ences
1. Saxena A, Sha ma S, Kuma R, e al.
Compa a i e e alua ion o unc ional
ou comes ollowing su gical and conse a i e
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