Nonunion of fibula: a systematic review

Abstract

Purpose The purpose of this systematic review was to analyse the available evidence regarding nonunions of the fibula. We focussed on the incidence, risk factors, evaluation, and treatment modalities for fibular nonunions as evident in the current literature and propose a treatment algorithm. Methods This was an Institutional Review Board (IRB) exempt study performed at a level one trauma centre. We systematically reviewed the published evidence on fibular nonunion or delayed union from 1950 to February, 2011. Results Twelve articles were included in this systematic review. In summary, nonunion of the fibula is becoming increasingly more common in association with intramedullary nailing of concomitant tibial shaft fractures. A treatment algorithm for nonunion of the fibula has been proposed. Conclusions The suspicion for nonunion of the fibula should be heightened in lower leg fractures if the patient is symptomatic, and the progression of healing is not as expected. Ideally, prospective, multicentre studies would be performed to provide more rigorous data on the incidence, risk factors, and optimum treatment.

Danis-Weber a Non-Union in a Teenager: A Case Report and Review of Literature

“…Factors that can increase the risk of non-union include increased age, obesity and history of smoking, none of which apply to our patient [2][3][4]11]. The patient is young, active and healthy with no history of substance or tobacco use.…”

“…However, non-unions do occur and several ways have been documented on how to treat them [3]. In a systematic review of fibula non-unions, Bhadra et al [3] reviewed the treatment options found in the literature [3].…”

“…When they are reported in the literature, it is most commonly rotational fibular fractures [2][3][4]. Walsh and DiGiovanni discuss one case of a DWA non-union in their retrospective case review [2].…”

“…Many of these are asymptomatic and require no treatment. The vast majority of literature discussing fibular nonunions pertains to fractures at or above the level of the tibio-talar joint [2][3][4][5][6][7][8][9]. To our knowledge, only one case of a Danis-Weber A (DWA) non-union has been discussed in literature at this time, which was treated with avulsion fragment excision [2].…”

“…When a fibula is fractured, 75-85% of the time it occurs concomitantly with a tibia fracture, often due to a rotational injury [2][3][4][5]. Stability of the fracture is assessed and when it is stable and non-displaced, conservative treatment is recommended, with satisfactory results [2,6].…”