Fibula fracture is associated with high rate of vascular injury among low velocity ballistic tibia fractures.

Objective: To evaluate whether the presence of a concurrent fibula fracture in low-velocity ballistic tibia fractures was associated with increased rates of vascular injury and compartment syndrome. We hypothesized that ballistic tibia fractures with an associated fibula fracture would have higher rates of vascular injury and compartment syndrome than isolated ballistic tibia fractures. Design: Retrospective cohort study. Setting: Single academic Level 1 trauma center. Patients: Adult patients aged 18 years or older who underwent surgical fixation for low-velocity ballistic tibia fractures between 2014 and 2024 were included. Patients with documented rifle or shotgun injuries were excluded. Intervention: Patients were stratified by fracture pattern into isolated tibia fracture and combined tibia-fibula fracture groups. Main Outcome Measurements: Primary outcomes were vascular injury identified on computed tomography angiography and compartment syndrome, defined by documented clinical diagnosis treated with fasciotomy. Results: Of 34 patients with ballistic tibia fractures, 11 (32.4%) had a concomitant fibula fracture. The tibia-fibula fracture group had a significantly higher rate of vascular injury than the isolated tibia fracture group (72.7% [8/11] vs. 8.7% [2/23], Conclusion: Among patients with low-velocity ballistic tibia fractures, the presence of a concomitant fibula fracture was associated with a higher rate of vascular injury. Level of Evidence: III.