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. 2012 Sep;36(9):1757-65.
doi: 10.1007/s00264-012-1556-z. Epub 2012 May 30.

Nonunion of fibula: a systematic review

Arup K Bhadra  1 , Craig S Roberts, Peter V Giannoudis
Affiliations

Nonunion of fibula: a systematic review

Arup K Bhadra et al. Int Orthop. 2012 Sep.

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.

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Figures

Fig. 1
Fig. 1
Flow chart depicting articles exclusion breakdown
Fig. 2
Fig. 2
Anteroposterior (AP) and lateral radiographs of tibia and fibula with tibial intramedullary nail in situ, showing hypertrophic nonunion of fibula (white arrow)
Fig. 3
Fig. 3
CT scans showing atrophic non-union of fibula
Fig. 4
Fig. 4
Lateral and anteroposterior (AP) views of ankle with internally fixed Weber B type fibula fracture five months post-surgery. The fracture line is barely visible on lateral X-ray (white arrow), but difficult to appreciate in AP view. The patient had a CT scan (Figure 4) confirming atrophic nonunion
Fig. 5
Fig. 5
Axial, sagittal and coronal views of CT scan of ankle showing incomplete nonunion (white arrow) of internally fixed Weber B type fibula fracture
Fig. 6
Fig. 6
Flow chart depicting treatment algorithm for nonunion of fibula
See this image and copyright information in PMC

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