A 35-year-old male semi-professional player presented for an assessment three weeks after an injury to his right lower leg. He describes having had a direct blow to his right lower leg in a tackle and sustaining a fracture. This was managed in the city where his team had travelled to play. He has now returned home and wants advice about his return to football.
On examination his surgical wounds have healed well. He was able to touch weight bear with crutches. He was neurovascularly intact.
X-rays from the time of injury show a grossly angulated fracture of the tibia, located at mid-third. This is associated with a segmental fracture of the fibula. The tibia fracture has a transverse orientation. X-ray images at the time of his follow-up visit show that the tibia fracture has been reduced and treated with an intramedullary nail. The fibula fracture has not been fixed. There is no significant callus formation.
This player was reassured that his tibia fracture had been treated appropriately and that this was likely to heal well. The potential significance of the segmental fibula fracture was discussed. It was outlined that he was more likely to have a more prolonged recovery and that he was at an increased risk of delayed union, or non-union. Given the transverse orientation of the tibia fracture he was encouraged to start progressively weight bearing with crutches. At four-month follow up he is walking pain-free, has resumed resistance training and is starting some walk-jog activities. There is still very little radiological evidence of healing at the fibula. It is anticipated that it will take a minimum of six months to return to play.
Segmental fractures have at least two fracture lines that together isolate a segment of bone. This type of fracture is frequently associated with high energy mechanisms and can involve devascularisation of the segmental fracture fragment. This means that they are frequently associated with increased morbidity and longer-term complications such as delayed union, non-union and/or infection. The optimal treatment of this type of fracture is not known. A recent review found only one paper that discussed segmental fibular fractures in association with a tibia fracture. This review, which had a very small sample size, showed that fixation of these segmental fibular fractures may make it less likely, rather than more likely, for them to heal. Based on the lack of available evidence to guide treatment decisions, expert orthopaedic review and a shared decision-making process should be used to help decide how best to proceed.
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.