DOI: https://doi.org/10.36347/sjams.2026.v14i05.006

Pages: 680-684

Background: Comminuted distal tibia-fibula fractures with compromised soft tissue present a significant surgical challenge due to the risk of wound complications, infection, and delayed bone healing. Traditional fixation of both tibia and fibula may exacerbate soft tissue injury, whereas only fibula fixation offers lateral column support while minimizing tibial dissection. Objective: To evaluate the clinical and radiological outcomes of only fibula fixation in comminuted distal tibia-fibula fractures with soft tissue jeopardization. Method: An interventional observational study was conducted from June 2024 to June 2025, including 20 patients with comminuted distal tibia-fibula fractures. Pathological fractures, or neurovascular compromise were excluded. Only fibula fixation was performed under spinal or general anesthesia, with early postoperative mobilization and gradual weight-bearing. Functional outcomes were assessed using the AOFAS score, and radiological union and alignment were evaluated per Johner and Wruh criteria. Complications, time to surgery, and bone healing parameters were recorded. Results: The majority of patients were male (63%) and aged 30–49 years (65%). Road traffic accidents accounted for 65% of injuries. According to AO classification, Type A fractures were most common (47%), and Grade IIIB was the predominant Gustilo-Anderson classification (36%). Surgery within 12 hours was achieved in 65% of patients. Partial weight-bearing was initiated within 4 weeks in 65%, full weight-bearing within 9 weeks in 55%, and bone union occurred within 21 weeks in 70% of patients. Postoperative complications included pin tract infection (26%), delayed union (32%), joint stiffness (28%), pin loosening (14%), shortening >2 cm (16%), and chronic osteomyelitis (16%). Conclusion: Only fibula fixation in comminuted distal tibia-fibula fractures with soft tissue compromise provides satisfactory fracture stabilization, functional recovery, and early bone union while m