The fibular reciprocal fracture in tibial shaft fractures caused by indirect violence.

A series of 200 consecutive junctional middle-distal third tibial shaft fractures caused by indirect violence was analysed with emphasis on the significance of the location of the fibular reciprocal fracture. The fibular fracture was eccentric, i.e. subcapital or malleolar, in 96 patients. This fracture pattern was encountered only in adults and showed significantly more severe initial displacement and with conservative treatment longer union time than fractures with intact fibula or the fibular fracture on the same level with the tibial fracture. Especially for fractures with an initial lateral displacement of more than one half of the diaphyseal diameter and with an eccentric fibular reciprocal fracture internal fixation with uncomplicated postoperative course shortened the union time and prevented residual deformity. A malleolar fibular fracture and the rare separate displaced posterior triangle fracture should in addition as such be regarded as indications for osteosynthesis.