Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Is a Fibula Fracture Non-Union?

A fracture non-union occurs when a fracture fails to heal — the bone ends do not bridge with new bone within the expected timeframe (typically 6–9 months for fibular fractures). A malunion is when the fracture heals, but in a non-anatomic position that impairs joint mechanics and function. Both conditions cause persistent pain, swelling, ankle instability, and difficulty with weight-bearing long after the initial injury should have resolved. Ankle fracture non-union and malunion are underrecognized causes of prolonged post-injury ankle pain — frequently dismissed as “normal” post-fracture aching when in fact they are structural problems requiring intervention. At Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan, Dr. Tom Biernacki, DPM evaluates and manages these complications. Call (810) 206-1402.

Why Non-Unions and Malunions Happen

Risk factors for fibular non-union: infection at the fracture site (suppresses osteoblastic activity); inadequate immobilization (excessive motion at the fracture site — non-compliance with boot or casting instructions); poor blood supply (peripheral vascular disease, smoking reduces bone blood flow by 25–40%); metabolic disorders (diabetes, hypothyroidism, vitamin D deficiency, chronic steroid use); osteoporosis; and initial fracture displacement that creates a large gap. Risk factors for malunion: inadequate fracture reduction at the time of treatment; loss of reduction during healing; and early weight-bearing before adequate callus formation in surgical cases.

Diagnosing Non-Union vs. Normal Healing Delay

The clinical distinction: normal post-fracture pain decreases progressively week over week and is absent with non-weight-bearing activities; non-union pain is persistent or worsening with weight-bearing, present even at rest, and remains present at 4+ months post-injury. Point tenderness directly at the fracture site persisting beyond 3 months is highly suggestive of non-union. Serial X-rays are the first imaging tool — absence of bridging callus at 4–6 months is the radiographic definition of non-union. CT scan more precisely defines the non-union gap and bone quality. MRI identifies associated soft tissue complications (tendon injury, osteochondral lesion). Bone scan (scintigraphy) distinguishes hypertrophic non-union (active healing attempt, better prognosis) from atrophic non-union (absent healing activity, requires intervention).

Conservative Management Options

Hypertrophic non-unions (bone attempting to heal but failing due to mechanical instability) may respond to: extended immobilization in a cast or pneumatic boot; bone stimulation devices (low-intensity pulsed ultrasound or electrical bone stimulation) — FDA-approved, improve non-union healing rates by 20–30% in appropriately selected cases; addressing underlying metabolic deficiencies (optimize vitamin D to >50 ng/mL, manage diabetes, cease smoking); and protected weight-bearing with crutches to eliminate fracture-site motion. Conservative management success rate for hypertrophic non-union with bone stimulation: 60–75%. Atrophic non-unions do not respond to conservative management and require surgery.

Surgical Management — Revision ORIF

Surgical treatment for fibular non-union: revision open reduction and internal fixation (ORIF) with bone grafting. The procedure involves: freshening the non-union surfaces to create a biologically active healing environment; applying autograft (typically from the iliac crest) or allograft bone to fill the gap; and rigid internal fixation with a plate and screws to eliminate motion at the site. For malunions: corrective osteotomy to restore anatomic fibular length and rotation, followed by plating. Malunion correction in the context of established ankle arthritis is more complex — combined osteotomy and cartilage restoration or arthrodesis may be required. Recovery: 8–10 weeks non-weight-bearing after revision surgery, 4–6 months to full activity.

Post-Fracture Ankle Arthritis — Managing the Long-Term Consequences

Both non-union and malunion increase the risk of post-traumatic ankle arthritis — the malpositioned or mechanically unstable ankle transmits abnormal force to the tibiotalar cartilage over time. Conservative management of post-traumatic arthritis: custom orthotics with a rigid ankle foot orthosis (AFO) or Arizona brace for joint stabilization; rocker-bottom shoe modifications; MLS laser therapy for synovitis; and corticosteroid or hyaluronic acid injections for symptom management. For advanced post-traumatic arthritis with failed conservative management: ankle arthrodesis (fusion) or total ankle replacement.

Ankle Fracture Complication Management in Howell & Bloomfield Hills Michigan

Dr. Tom Biernacki, DPM evaluates ankle fracture non-unions, malunions, and post-fracture complications at Balance Foot & Ankle — serving Howell, Brighton, Bloomfield Hills, Troy, Auburn Hills, West Bloomfield, and all Southeast Michigan. If your ankle fracture “healed” but you still have persistent pain or instability at 4+ months, seek a second opinion evaluation. Book online or call (810) 206-1402.

Fibula Fracture Complications Specialist in Michigan

Fibula fracture non-union and malunion cause chronic ankle pain and instability that may require corrective surgery. Our surgeons evaluate poorly healed fractures and provide revision fixation, bone grafting, and realignment procedures.

Learn About Our Ankle Fracture Treatments → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. SooHoo NF, et al. Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am. 2009;91(5):1042-1049.
2. Bauer M, et al. Malleolar fractures: nonoperative versus operative treatment. Clin Orthop Relat Res. 1985;(199):17-27.
3. Michelson JD. Fractures about the ankle. J Bone Joint Surg Am. 1995;77(1):142-152.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.