Fibula-first fixation in same-level distal third tibia and fibula fractures: A pilot randomized controlled trial
Bibliographic record
Abstract
Introduction Fractures of the tibia and fibula occurring at the same level can be technically challenging. Fibular plating (FP) prior to intramedullary nailing (IMN) may facilitate tibial reduction, stabilization, and subsequent tibial healing. The primary goal of this study was to compare tibial fracture healing between FP and no fibular plating (NFP) in patients with same-level distal third tibia/fibula fractures. Methods Patients ≥18 years with distal third tibia/fibula fractures occurring at the same level were randomized to FP or NFP prior to infrapatellar IMN. Same-level fractures were defined as distal third tibia fractures with an ipsilateral supra-syndesmotic distal third fibula fracture. Intraoperative parameters, patient-reported outcome measures (PROMs), modified Radiographic Union Scale in Tibial fractures (mRUST) scores, radiographic alignment, and adverse events were recorded. Results 30 patients were recruited, with 15 randomized to each group. There were no differences in baseline characteristics between groups. Total operative time was longer in FP compared with NFP (105.5 vs 65.8 minutes, p = .001). Mean duration of fibular fixation was 28.1 minutes (SD = 11.9). There was no difference in duration of IMN; however, less time was required to pass the guidewire in FP (4.5 vs 11.8 minutes, p = .01). Patients in FP had higher mRUST scores at 6 months, lower incidence of delayed union, and shorter fibular time-to-union. There were no differences in alignment between groups. Conclusion Fibula-first fixation facilitated passage of the tibial guidewire and resulted in a modest improvement in the rate of tibia fracture healing. The results of this pilot study suggest that fibula-first fixation may be beneficial in patients with same-level distal third tibia/fibula fractures. Further research with larger sample sizes is needed to determine which patients may benefit most from fibula-first fixation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".