Role of the fibula in lower leg fractures: An in vivo investigation in rats

Whether or not the fibula should be fixated in combined fractures of the tibia and fibula remains controversial. Several clinical and biomechanical studies have investigated the role of the fibula in lower leg fractures without leading to a common conclusion. We assumed that an intact or stable fibula would provide better healing conditions in lower leg fractures treated with an intramedullary nail. In an in vivo study, 40 male Wistar rats were randomly assigned to two groups. In both groups, the tibia was osteotomized, whereas the fibula was left intact in one group and osteotomized in the other group. The tibia fracture was fixated with an intramedullary nail. After sacrifice of the animals, mineral density, mineral content, and mechanical characteristics of the healing osteotomies were evaluated. We found that a combination of tibia and fibula fracture significantly impaired fracture healing during the early phase after the incident, when treated with an intramedullary nail, suggesting that an intact or stabilized fibula provides additional support and better healing conditions to a tibia fracture.