Management of Hypertrophic non-Union After Isolated Fibular Shaft Fracture With Percutaneous Screw Fixation: A Case Report

Hypertrophic non-union, after an isolated fibular fracture with intact tibia, is an extremely uncommon complication. The aim of the current study is to present an infrequent case of hypertrophic non-union after an isolated fracture in the proximal diaphysis of fibula which was treated surgically. A 23-year-old male patient presented to our hospital with persistent pain on the lateral aspect of his right leg. He had sustained an oblique isolated fracture in the proximal diaphysis of the fibula after a direct blow to the tibia nine months previously, during a football game, which had been treated conservatively. A hypertrophic non-union was identified on radiographs. Initially, a weight-bearing (WB) cast was placed for one month. However, no sign of union was visible in the new X-rays whereas the symptoms had not subsided. Therefore, a percutaneous osteosynthesis was performed under fluoroscopy with a 3.5 mm lag screw. Immediate mobilization and partial weight-bearing was recommended postoperatively. At six weeks, full WB was allowed, while at eight weeks, radiographic imaging displayed complete union. At 12 weeks postoperatively, the patient returned to his daily routine without any symptoms. Only few studies in literature report non-union as a complication after isolated fibular fractures. In such cases, minimally invasive percutaneous osteosynthesis with a lag screw can offer a successful and definite outcome.