J Korean Foot Ankle Soc.  2018 Sep;22(3):95-99. 10.14193/jkfas.2018.22.3.95.

The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures

Affiliations
  • 1Department of Orthopaedic Surgery, Chosun University Hospital, School of Medicine, Chosun University, Gwangju, Korea. leejy88@chosun.ac.kr

Abstract

PURPOSE
The purpose of this study was to evaluate the radiologic outcomes of distal fibular fractures and to analyze the risk factors associated with nonunion.
MATERIALS AND METHODS
Between January 2009 and March 2016, 13 patients who had final nonunion with ankle fracture were included. In the control group, 370 patients who had undergone bony union and removed metal implants were included. All patients underwent the same surgical procedure and had the same treatment method, ultimately achieving satisfactory open reduction results with less than 2 mm fracture gap. Surgical treatment of fracture was considered to have the same effect on nonunion, and factors that might be associated with nonunion were evaluated. SPSS ver. 13.0 (SPSS Inc., USA) was used for all statistical analyses. Pearson's chi-square test and multi-variate regression analysis were performed to determine the factors affecting nonunion of distal fibular fracture. A p-value less than 0.05 was considered statistically significant, and relative risk was assessed.
RESULTS
The mean age of 13 patients was 46.9 years (range, 16~57 years); there were 8 men and 5 women. Among the 13 patients with nonunion, atrophic was the most common (12 cases). The association between the injury mechanism and the Lauge-Hansen classification and diabetes mellitus was not statistically significant. Distal fibular fractures with tibia shaft fracture (p=0.015) and Danis-Weber type C fracture (p=0.023), open fracture (p=0.011), and smoking (p=0.023) were significantly associated with nonunion.
CONCLUSION
In this study, the combined injury of the ipsilateral tibia shaft fracture, open fracture, and Danis-Weber type C fracture may increase the possibility of nonunion. Therefore, caution is advised to prevent nonunion.

Keyword

Distal fibula fractures; Nonunion

MeSH Terms

Ankle Fractures
Classification
Diabetes Mellitus
Female
Fractures, Open
Humans
Male
Methods
Risk Factors*
Smoke
Smoking
Tibia
Smoke

Figure

  • Figure 1. A 68-year-old male with lateral malleolar fracture (Denis-Weber type B, Lauge-Hansen supiration-external rotation type) visited our clinic after conservative treatment. (A, B) Ankle anteroposterior and lateral view taken 6 months after the injury showed lateral malleolar nonunion. (C, D) Ankle computed tomography showed sclerotic lesion of the fracture site and fracture gap. (E, F) He underwent plate and screw fixation of the fibula with autogenous iliac crest bone graft. Radiographs taken 9 months postoperatively demonstrate complete healing. He had diabetes, smoking of nonunion risk factors.

  • Figure 2. A 40-year-old male presents for evaluation of continued ankle pain 8 months after open reduction and internal fixation of a bimalleolar fracture. (A) Initial ankle anteroposterior view at injury shows left ankle bimalleolar fracture (Denis-Weber C, Lauge-Hansen pronation-external rotation type) with syndesmosis injury. (B) Internal fixation was performed using a cannulated screw and 1/3 semitubular plate. (C, D) Radiograph and computed tomography demonstrate an atrophic nonunion. (E) The patient underwent operative revision with iliac crest bone graft.


Reference

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