Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures

원위 비골 골절의 수술 후 발생한 불유합의 관련 인자

  • Lee, Jun Young (Department of Orthopaedic Surgery, Chosun University Hospital, School of Medicine, Chosun University) ;
  • Choi, Kwi Youn (Department of Orthopaedic Surgery, Chosun University Hospital, School of Medicine, Chosun University) ;
  • Kang, Sinwook (Department of Orthopaedic Surgery, Chosun University Hospital, School of Medicine, Chosun University) ;
  • Ko, Kang Yeol (Department of Orthopaedic Surgery, Chosun University Hospital, School of Medicine, Chosun University)
  • 이준영 (조선대학교 의과대학 조선대학교병원 정형외과학교실) ;
  • 최귀연 (조선대학교 의과대학 조선대학교병원 정형외과학교실) ;
  • 강신욱 (조선대학교 의과대학 조선대학교병원 정형외과학교실) ;
  • 고강열 (조선대학교 의과대학 조선대학교병원 정형외과학교실)
  • Received : 2018.06.25
  • Accepted : 2018.08.31
  • Published : 2018.09.15
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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.

Keywords

References

  1. Bhadra AK, Roberts CS, Giannoudis PV. Nonunion of fibula: a systematic review. Int Orhop. 2012;36:1757-65. https://doi.org/10.1007/s00264-012-1556-z
  2. Hak DJ, Fitzpatrick D, Bishop JA, Marsh JL, Tilp S, Schnettler R, et al. Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury. 2014;45 Suppl 2:S3-7.
  3. Kang CH, Jung JH, Ye HU, Cho CH. Associated factors of nonunion following conservative management of distal clavicle fractures. J Korean Orthop Assoc. 2015;50:137-42. https://doi.org/10.4055/jkoa.2015.50.2.137
  4. Guo F. Observations of the blood supply to the fibula. Arch Orthop Trauma Surg. 1981;98:147-51. https://doi.org/10.1007/BF00460804
  5. Walsh EF, DiGiovanni C. Fibular nonunion after closed rotational ankle fracture. Foot Ankle Int. 2004;25:488-95. https://doi.org/10.1177/107110070402500708
  6. Ko SB. Relationship of tibial nonunion with fibular nonunion in the tibio-fibular shaft fracture. J Korean Fract Soc. 2006;19:153-6. https://doi.org/10.12671/jkfs.2006.19.2.153
  7. Shin DE, Cho DY, Yoon HK, Lee JS, Lee YS, Kim HJ. The effect of fibular malreduction on ankle joint after tibial interlocking IM nailing of tibial and fibular fractures. J Korean Fract Soc. 2005;18:29-35. https://doi.org/10.12671/jkfs.2005.18.1.29
  8. Siliski JM, Healy W, Carr C, Baumgaertner M, Blitzer C. Nonunion of the fibula after ankle fracture. J Orthop Trauma. 1993;7:198.
  9. Ahmed M, Wimhurst JA, Walton NP. Non-union of Weber B fractures: a case series. Injury. 2007;38:861-4. https://doi.org/10.1016/j.injury.2006.07.041
  10. Guille JT, Lipton GE, Bowen JR, Uthaman U. Delayed union following stress fracture of the distal fibula secondary to rotational malunion of lateral malleolar fracture. Am J Orthop (Belle Mead NJ). 1997;26:442-5.
  11. Song KS, Kim HG, Park BM, Moon CS, Kim BY. Treatment of lateral malleolar fracture associated with disruption of the deltoid ligament. J Korean Orthop Assoc. 2010;45:210-5. https://doi.org/10.4055/jkoa.2010.45.3.210
  12. Yablon IG, Leach RE. Reconstruction of malunited fractures of the lateral malleolus. J Bone Joint Surg Am. 1989;71:521-7. https://doi.org/10.2106/00004623-198971040-00007
  13. Dodson NB, Ross AJ, Mendicino RW, Catanzariti AR. Factors affecting healing of ankle fractures. J Foot Ankle Surg. 2013;52:2-5. https://doi.org/10.1053/j.jfas.2012.10.013

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