Association Between Tibial Malunion Deformity Parameters and Degenerative Hip and Knee Disease

Tibia fractures are the most common long bone fracture. Criteria for closed and open reduction are based on the amount of fracture shortening, angulation, and rotation, with high success rates achieved if acceptable alignment is maintained. However, there exists limited data available regarding the long-term consequences of specific deformation patterns.

The tibiae of 2898 cadaveric skeletons were manually inspected for evidence of fracture. Specimens with midshaft fractures were identified as candidates for study; intraarticular fractures were excluded. Fracture shortening, location, angulation, rotation (torsion), and translation were measured using previously described techniques. Degenerative joint disease of the knee and hip was graded from 0 to 3 in fracture specimens using a previously published system. Correlations between fracture characteristic and osteoarthritis were evaluated.

Thirty-seven tibia fractures were present in 36 skeletons. In patients with tibia fractures, ipsilateral knee arthritis was greater than that of the contralateral side (P < 0.001). Knee arthritis was greater in fractures with coronal plane deformity greater than 5 degrees (P = 0.006) and with rotational deformity greater than 10 degrees (P = 0.004). There were no differences in knee arthritis based on laterality, shortening, sagittal deformity, fracture type, or translation in any plane (P > 0.05 for all). There were no differences in hip arthritis on the ipsilateral side compared with the contralateral side (P = 0.149). However, tibiae that were shortened by more than 10 mm had higher grades of ipsilateral hip arthritis (P = 0.009).

The results of this study suggest that coronal and axial plane malalignment and shortening are of the greatest consequence following tibia fracture. These conclusions strengthen the recommendations of authors who have emphasized restoring tibial length following fracture, and providing anatomic restoration in the coronal and axial planes.