[Role of the fibula in distal tibial fracture]

Analysing 1077 fractures of the distal segment of the tibia the author found specific morphologies of the accompanying fibula fractures when axial dislocations exist. In valgus position compression and bending forces induce multifragmentary fractures of the diaphysis or impactions of the metaphysis. In varus position bending and traction forces create simple oblique or transverse fractures. The ligaments of the syndesmosis are rarely ruptured when the fibula is fractured. They may remain undamaged when the fibula is intact. Ruptures of the fibulotalar and fibulocalcanear ligaments are not uncommon. The internal fixation of the fibula remains the first step of the AO-tactics for the operative treatment of Pilon-tibial fractures. The initial axial position must be respected. In valgus cases there will be postoperative compression forces (pillar function), in varus cases traction forces (tension band function) acting on the repaired fibula. Indirect reduction techniques ought to be used for complex fibula fractures.