Do Fibula Nonunions Predict Later Tibia Nonunions?

OBJECTIVES: The purpose of this study was to evaluate the validity of fibula nonunion as a method for predicting tibia nonunion in the tibiofibula shaft fracture. DESIGN: Retrospective study. SETTING: University hospital. MATERIALS AND METHODS: From March 1998 to October 2008, 224 patients were enrolled. Among 224 patients, 153 patients were treated with intramedullary nail, 34 patients were treated with external fixator, 32 patients with plate and screws. The remaining 5 patients were treated nonsurgically with cast or brace. Patients followed up at 1, 2, 3, 6, 9, 12, and 18 months postoperatively. Multivariate analysis of the relationship between fibula and tibia union was conducted. RESULTS: Among the 224 patients, 169 patients were included in the fibula union group and 55 patients were in the fibula nonunion group. Mean age was 49 years (19-89 yrs); follow-up period was more than 18 months (18-109 mo). In the fibula union group, there were 21 patients (12.4%) with a tibia nonunion. In the fibula nonunion group, 21 patients (56.3%) had tibia nonunion. Fibula nonunion was significantly statistically associated with tibia nonunion (P = 0.002). Union time between the tibia and the fibula was statistically significant (P = 0.002). CONCLUSION: Fibula nonunion is a good predictor of tibia nonunion in patients with tibiofibula shaft fractures. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.