Updated and cleaned up. This is a part of a larger series on Sports Injuries – Paragon
This is what Stanley Havili’s cracked Fibula might look like from last night’s game. Based on what I have read it appears not to be serious enough to require surgery. He will probably be treated conservatively in a cast and be out for 6-8 weeks. Havili's injury was not described as being either proximal (near the top) or distal (near the bottom) of the fibula so I have provided to x-rays that describe both injuries.
This type of injury is usually treated non-operatively or closed but there are some things to watch out for.
Indication for Closed Treatment:
- chief indication of closed treatment is enough overlap to initiate early wt bearing; at least 50% cortical overlap at the fracture site.
- more than 50% initial fracture displacement will significantly increase risk of loss of reduction and non-union, due to instability of fracture.
- unstable fractures of tibia/fibula may be treated by closed reduction & casting, however, malunion may occur. - initial shortening of more than 2 cm is a contra-indication for casting, since this amount of shortening would be expected with weight bearing (despite the success of the initial reduction); OM Bostman et. al. JBJS 68-B (3) 1986. p 462-466.
Prognosis for Fracture Healing:
- more than 50% cortical comminution or displacement more than 50% are significant risk factors for non-union. - With a stable fracture the average time for union is 4 to 5 months, with a range of 2 to 14 months. - 1-2 % refracture and 1-2 % require surgical bone grafting for union. - nonunion occurs in 2-5%, malalignment occurs in 3% to 8%, and shortening of more than 1 cm occurs in as many as 10% of patients.