Partial Fibulectomy for Symptomatic Fibular Nonunion

Abstract

Level of Evidence: V, Expert Opinion

Nonunion of fibula: a systematic review

“…The age range was from ten years to 72 years. The range of follow-up (from three months to 23 years) was reported in eight articles only [1][2][3][4][7][8][9][10]. In combined tibia/fibula fractures, fibular nonunion occurred more commonly when the tibia was stabilised with intramedullary nails (5.5 % in the nail group, 4.14 % in the plate group, and none in the conservative group) [1,4,5].…”

“…CT scan as a diagnostic radiological investigation was used in only less than 20 % of the cases. CT scan was more useful in cases with suspected concomitant incomplete union of the tibia [4] and in cases of Weber B type ankle fractures [6,[8][9][10] where the extent of fibular union was sometimes difficult to appreciate on plain X-rays (Fig. 4).…”

“…Generally, it should be considered in nonunions involving the middle third of the shaft of the fibula. In order to preserve normal ankle and knee mechanics, the published recommendation is to make the most distal and proximal resection a minimum of five to six centimetres from the respective ends of the fibula [9,24]. Overall, seven cases (5.9 %) were treated by segmental resection which resulted in complete resolution of pain [1,5,9].…”

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

“…These include further conservative management, bone stimulation, external fixation, percutaneous drilling, bone grafting and ORIF with or without bone grafting, arthrodesis, excision and segmental resection [3,8]. Segmental resection, however, is not recommended for fractures close to the ankle joint, such as this patient's [8]. Bhadra et al [3] also provided a treatment algorithm that recommends ORIF with bone grafting for atrophic nonunions of the distal third fibula, which is what we did.…”

“…In a systematic review of fibula non-unions, Bhadra et al [3] reviewed the treatment options found in the literature [3]. These include further conservative management, bone stimulation, external fixation, percutaneous drilling, bone grafting and ORIF with or without bone grafting, arthrodesis, excision and segmental resection [3,8]. Segmental resection, however, is not recommended for fractures close to the ankle joint, such as this patient's [8].…”