Isolated fibular shaft fracture in a sprinter

Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures

INTRODUCTION

Dynamisation is a simple method for treating femoral shaft fractures (FSFs) in patients with delayed healing after intramedullary nailing. However, only around half of patients with a slow-healing FSF have been successfully treated with this strategy. Although it is thought that dynamisation with a screw preserved in the dynamic locking hole improves treatment outcome in these patients, to date, no studies have demonstrated empirical evidence supporting this technique. In this study, we investigated the effects of dynamisation with and without rotation and length control as well as timing of dynamisation on treatment outcomes in FSF patients with delayed healing.

PATIENTS AND METHODS

Thirty-nine consecutive acute FSF patients with static locking intramedullary nails who subsequently underwent dynamisation were recruited between January 2000 and June 2011. The indication for dynamisation was the presence of gap caused by bone absorption or over-traction at the fracture site when the locking screws were placed. Age, gender, dynamisation method, fracture classification, duration from nail insertion to dynamisation (i.e., timing of dynamisation) and dynamisation outcome were included in the statistical analysis.

RESULTS

Patients whose nail was dynamised with a screw preserved in the dynamic locking hole had a significantly higher successful bone union rate (14/15 vs. 14/24, p=0.028) compared with those with all screws removed from one end of the nail. The patients treated in 10-24 weeks had a significantly increased chance of bone union than those treated after 24 weeks (p=0.027). A significantly higher bone union rate (p=0.036) was observed in 10-24 weeks (83.3%) than after 24 weeks (33.3%) in the group of dynamisation with all screws removed from one end of the nail. No statistical difference in bone union success rate was found between patients at 10-24 weeks and after 24 weeks in the group of dynamisation with a screw preserved in the dynamic locking hole. There were no significant differences in outcome based on other variables.

CONCLUSION

(1) Dynamisation with a screw preserved in the dynamic locking hole was associated with a higher success rate in bone union than all screws removed from one end of the nail for patients with delayed healing FSFs. (2) Early dynamisation (10-24 weeks) had a better outcome than late dynamisation (>24 weeks). Late dynamisation with all screws removed from one end of the nails resulted in a poor success rate. Alternative treatment should be considered if the latter approach is to be adopted.

Case report: Fatigue fracture of the proximal fibula with secondary common peroneal nerve injury

Stress fractures of the proximal fibula are uncommon and usually result from axial loading, which is mostly described in runners. We report an unusual mechanism of such a fracture in a circus performer resulting from repetitive direct horizontal loading from a trapeze bar. In addition, the bony injury resulted in a secondary injury to the common peroneal nerve with corresponding weakness. Both injuries responded well to nonoperative treatment and the athlete had an excellent recovery with no residual symptoms. He was able to resume his training with the use of protective padding applied to the proximal legs. Fracture of the proximal fibula caused by direct repetitive stress to the bone with a secondary compression injury to the common peroneal nerve is a previously undescribed injury. We report a patient who presented with this injury, the possible mechanisms of such injury, its management, and outcome.

Bilateral proximal third fibular stress fractures in an adolescent female track athlete

Proximal fibular stress fracture is an uncommon injury in athletes but has been frequently reported in the military population. Although the true incidence is unknown and its pathophysiology is not completely understood, proximal fibular stress fracture is believed to be a rare injury and awareness of it will help clinicians make the proper diagnosis and provide appropriate treatment.

Stress fracture of the proximal fibula in a young soccer player: a case report and a review of the literature

A 14-yr-old soccer player complained of a history of leg pain with activity that had been present for several weeks. There was no history of direct trauma. Tenderness was found over the lateral aspect of the leg, and radiographs showed an area of calcification along the shaft of the proximal fibula. Because of the unusual location of the findings and to exclude a tumor, magnetic resonance imaging (MRI) was obtained which confirmed the diagnosis of a proximal fibular stress fracture. The patient returned to full sport participation with a period of relative rest, splinting, and strengthening and flexibility training. This case describes an injury that has not been reported in young athletes and only rarely described in active adults. The literature regarding this injury is reviewed, and two injury patterns of proximal fibular stress fractures are described.

Traumatic fibular shaft fractures in athletes

A direct blow to the leg resulted in fibular shaft fractures in three elite college athletes participating in contact sports. None of the athletes had prior symptoms suggestive of a stress fracture. All three athletes had benign-appearing fractures and were treated nonoperatively. Ultimate healing was delayed, occurring on average at 23 weeks, and each case was complicated by refracture. Fractures of the fibular shaft in athletes may require more aggressive treatment than other simple fractures to allow sufficient healing to withstand the rigors of athletics.