Nonunion of fibula: a systematic review.
OBJECTIVE
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.
Department of Orthopaedic Surgery, University of Louisville, 550 S Jackson Street, 1st Floor, ACB, Louisville, KY 40202, USA.
Arup K
AK
Bhadra
Craig S
CS
Roberts
Peter V
PV
Giannoudis
D000465:Algorithms; D015897:Comorbidity; D005360:Fibula / Q000293:injuries* / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects; D005599:Fractures, Ununited / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D011183:Postoperative Complications; D013978:Tibial Fractures / Q000453:epidemiology; D014193:Trauma Centers