NONUNION OF PEDIATRIC FIBULA FRACTURES - EASY TO OVERLOOK, PAINFUL TOIGNORE

Fracture non-union in the pediatric population may span the age range from childhood to adolescence. Fracture non-union in children and adol escents is often due to an underlying cause such as affliction with ne urofibromatosis or osteogenesis imperfecta. Although less commonly see n, non-union may occur in the otherwise healthy pediatric population. We report three cases of fracture non-union of the distal end of the f ibula in the pediatric age group. All three were characterized by pers istent local pain and tenderness following injury with radiographic ev idence of fracture non-union. All three had undergone conservative tre atment with extended periods of immobilization. Following surgery, all three had marked improvement of their local symptomatology. One patie nt's course was complicated by reflex sympathetic dystrophy syndrome. In two patients, resection of the un-united fragment at the distal fib ula resulted in marked relief from pain without any increase in ankle instability. We postulate that the fracture non-union resulted in a fi brotic reaction that was so extensive that ankle stability was maintai ned even after removal of the fracture fragment.