Treatment of severe comminuted tibia-fibula fractures is often complicated by non-union, delayed union, and malunion. The best surgical approach is controversial. Aim: To compare the clinical outcomes and complications of three methods of fixation: elastic intramedullary nails and external fixation (EINE), plates, and interlocking nails (IN). Methods: This was a retrospective cohort study of 86 diaphysealtibia-fibula fractures in 80 patients treated with EINE, plate, or IN. Treatment outcomes

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... re compared in terms of the length of the hospital stay, time to union, and complication rates (loss of reduction requiring a reoperation, malunion, non-union, refracture, infection, and the need for a reoperation other than routine hardware removal). Mean follow-up was 17.4 months. Results: Length of hospital stay was similar among the three groups. Time to clinical union was longer with plate (P<0.05). Complications were more frequent with the interlocking nail (P=0.004). There was a loss of reduction in 7% of fractures treated with EINE, 11% of fractures treated with plate, and 13% of fractures treated with IN. Time to union was 12.5±5.6 months for EINE, 24.5±9.5 months for plate, and 14.5±8.2 months for IN. During follow-up, three patients (two with IN and one with EINE) had ≥2.0 cm of shortening of the affected limb; 25%, 43%, and 37% of patients treated with EINE, plate fixation, and IN, respectively, required a reoperation. Conclusion: Complication rates were similar between the three treatment approaches. Minimally invasive EINE for multi-segment and long-spiral mild-to-moderate comminuted closed tibia-fibula fractures achieved satisfactory outcomes and fast healing.