The role of fibular osteotomy in rotational osteotomy of the distal tibia.

A randomized prospective study was undertaken to assess the role of fibular osteotomy in distal tibial derotational osteotomies. Thirty-five patients were randomized to "intact fibula" and "osteotomized fibula" groups. There were no statistically significant differences in the amount of intraoperative derotation, time to weight bear, time to healing, and the amount of correction retained at follow-up between the two groups. Complications in the intact fibula group included one delayed union and one recurrence. In the osteotomized fibula group, there were two cases of loss of fixation, two pin-tract infections, one delayed union of tibia, one pressure sore in the cast, one distal tibial physeal arrest, and one recurrence. Although the difference in the complication rate between the two groups did not reach statistical significance, our results suggest that in distal tibial derotational osteotomies, fixed with cross pins, it might be advantageous to leave the fibula intact.