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. 2025 Nov 16;10(4):24730114251388097.
doi: 10.1177/24730114251388097. eCollection 2025 Oct.

Intramedullary Nailing vs Plate Fixation of the Fibula in the Setting of Distal Tibial Fractures Requiring ORIF: National Readmissions Database Propensity Score-Matched Analysis

Gnaneswar Chundi  1 , Abhiram Dawar  1 , Ian Briggs  1 , David B Ahn  1 , Avani A Chopra  2 , Zachary Fuller  1 , Sheldon S Lin  1 , Tuckerman Jones  1
Affiliations

Intramedullary Nailing vs Plate Fixation of the Fibula in the Setting of Distal Tibial Fractures Requiring ORIF: National Readmissions Database Propensity Score-Matched Analysis

Gnaneswar Chundi et al. Foot Ankle Orthop. .

Abstract

Background: Most cases of tibia and fibula shaft fractures are treated without fixation of the fibula. However, there are some cases where fibula fixation is thought to improve patient outcome. The fibula can be stabilized by surface plating or medullary nailing but literature comparing these 2 fixation techniques is limited. This study evaluates postoperative complications and readmission rates between intramedullary (IM) nailing and surface plating of fibular fractures in patients undergoing concomitant tibial osteosynthesis.

Methods: Using the Nationwide Readmissions Database (NRD) from 2016 to 2021, we identified patients undergoing tibial open reduction and internal fixation (ORIF) for distal tibial fractures with concurrent fibular fixation using either IM nailing or plate fixation were identified. Propensity score matching was performed to balance demographic and clinical covariates. The prespecified primary endpoint was overall 90-day wound/infectious complications; secondary outcomes included specific complications and 30- and 90-day readmissions.

Results: After matching, 3497 IM nailing cases and 3381 plating cases were included. Baseline characteristics were similar between groups. IM fixation was associated with significantly lower rates of overall complications (7.5% vs 9.8%, P = .001), wound dehiscence (0.6% vs 1.8%, P < .001), infection (1.3% vs 2.8%, P < .001), malunion (0.4% vs 0.9%, P = .018), and abscess formation (0.1% vs 0.4%, P = .039). Although 30-day and total readmission rates were similar, the plate fixation group had significantly higher rates of infection- and wound-related readmissions.

Conclusion: In patients undergoing tibial ORIF for distal tibial fractures, adjunctive fibular IM nailing is associated with fewer wound-related complications and infections compared with plate fixation, without compromising union or readmission rates. IM nailing may be a lower-morbidity alternative for selected patients, pending prospective studies that incorporate fracture morphology and functional outcomes.

Level of evidence: Level III, prognostic.

Keywords: IM nailing; ORIF; fibula fracture; statistical analysis; tibial fracture.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.

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