Radiographic Healing of Conservative Versus Operative Management of Supination–External Rotation II Fractures in a Smoking and Premature Weight-bearing Population

The treatment of supination-external rotation II fibular fractures continues to be an area of debate. In the event of minimal displacement at the fracture, both surgical management and casting have been supported. This study aims to compare the time interval of radiographic healing in both the surgically and conservatively managed patient. Additional factors such as premature weight bearing and smoking were also examined. Fifty-two charts were examined retrospectively. This included 26 patients in both the surgical and conservative populations. Radiographs were examined for the presence of healing. Anterior-posterior, mortise, and lateral-view x-rays were examined. The presence of cortical bridging and a resolution of fracture line primarily on lateral view at the posterior spike were used to evaluate healing. The mean time for cortical bridging to occur was 89.38 days in the conservative group and 48.69 days in the surgical group. Mean times for healing were significantly longer in both smokers and patients who prematurely bore weight when treated in both the surgical and conservative populations. In the treatment of isolated fibular fractures, surgical intervention appears to offer a faster time to radiographic healing. Smoking and premature weight bearing are shown to prolong the time to radiographic healing in both the surgically and conservatively treated patient populations.