Evaluation of Lower Tibial Metaphyseal Plate Osteosynthesis with or without Fixation of Lateral Malleolar Fracture – A Prospective Study

Background: Distal tibial metaphyseal fractures, with or without associated lateral malleolar fractures, are common injuries resulting from high-energy trauma. The role of fibular fixation in improving stability and outcomes remains debated. Objective: To evaluate the functional and radiological outcomes of plate osteosynthesis of distal tibial metaphyseal fractures with or without fibular fixation in 40 patients. Methods & Materials: A prospective study was conducted on 40 patients with distal tibial metaphyseal fractures, managed by plate osteosynthesis. Patients were divided into two groups: Group A (n=20) – tibial fixation only; Group B (n=20) – tibial fixation with fibular plating. Functional outcome was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and radiological union was monitored over 12 months. Results: Mean union time in Group A was 19.2 weeks vs. 17.6 weeks in Group B. Malalignment (>5°) occurred in 4 patients (Group A: 3, Group B: 1). Mean AOFAS scores at final follow-up were 84.3 (Group A) vs. 88.6 (Group B). Complications included superficial infection (3 cases), delayed union (2 cases), and ankle stiffness (2 cases). Conclusion: Fibular fixation in addition to tibial plating provides better alignment and marginally faster union, with improved functional outcomes. However, differences were not statistically significant. Selective fibular fixation may be considered, especially in cases with instability or comminution.