Fracture, Fibula

By admin On Dec 2, 2023

Ovid: 5-Minute Sports Medicine Consult, The

Fracture, Fibula

Anna Waterbrook

Stephen Paul

Holly McNulty

Basics

Description

Isolated fracture of the shaft of the fibula without evidence of associated ligamentous injury
Synonym(s): Fibula shaft fracture; Fibula diaphyseal fracture

Epidemiology

Isolated fibula shaft fractures are rare.

Risk Factors

Direct blow or trauma to the lateral leg leading to injury of the fibular shaft
Contact sports or sports that require high repetitive axial loading may make some athletes more susceptible (1,2,3)[C].

Diagnosis

History

Patients usually will describe direct trauma to the lateral leg and complain of pain and swelling in that area. They may be able to bear weight with minimal or no pain.

Physical Exam

Tenderness to palpation over the fracture site with evidence of swelling and possible ecchymosis
It is important to examine the ankle and the knee for concomitant injuries, including proximal fibula fracture, distal fibula or tibia fracture, or injury to the syndesmosis.
Detailed neurovascular exam with particular attention to the peroneal nerve

Diagnostic Tests & Interpretation

Imaging

Radiographs of the tibia/fibula with anteroposterior and lateral views
Stress views or radiographs of the knee and ankle if suspicion for associated injuries exists.
No further imaging is necessary for isolated fibular shaft fractures.

Differential Diagnosis

Fracture or injury to the knee, ankle, tibia, proximal or distal fibula, peroneal nerve, and/or anterior syndesmosis.

P.195

Treatment

Treatment is based on patient comfort.
If patient is having pain with ambulation, then a splint, cast, or walking boot should be used.
Otherwise, a compression dressing is sufficient.
Immobilization for 3–4 wks generally is recommended, followed by graded progression back to sport.
Healing time usually takes about 6–8 wks but may be prolonged in some athletes (3)[C].

Additional Treatment

Additional Therapies

Patient should be referred to an orthopedic surgeon if fracture is communited, significantly displaced, there is an associated fracture of the tibia, or there is evidence of neurovascular injury or painful nonunion.
Special attention should be given to evaluation of the syndesmosis and peroneal nerve (1,4,5)[C].

References

1. Al-Kashmiri A, Delaney JS. Fatigue fracture of the proximal fibula with secondary common peroneal nerve injury. Clin Orthop Relat Res. 2007.

2. King WD, Wiss DA, Ting A. Isolated fibular shaft fracture in a sprinter. Am J Sports Med. 1990;18:209–210.

3. Slauterbeck JR, Shapiro MS, Liu S, et al. Traumatic fibular shaft fractures in athletes. Am J Sports Med. 1995;23:751–754.

4. Cheung Y, Perrich KD, Gui J, et al. MRI of isolated distal fibular fractures with widened medial clear space on stressed radiographs: which ligaments are interrupted? AJR Am J Roentgenol. 2009;192:W7–W12.

5. Mino DE, Hughes EC. Bony entrapment of the superficial peroneal nerve. Clin Orthop Relat Res. 1984;203–206.

Codes

ICD9

823.21 Closed fracture of shaft of fibula
823.31 Open fracture of shaft of fibula

Clinical Pearls

Patients will need to be in a cast for 3–4 wks.
The fracture will heal in 6–8 wks.
Depending on symptoms, rehabilitation may begin at 4–6 wks and training at 6–8 wks. Return to contact activities may take longer and has increased risk of refracture (3)[C].
Usually there are no complications, but a small percentage may result in nonunion, peroneal nerve injury, or associated damage to the interosseus membrane (1,2,3,4,5)[C].
Careful evaluation of the mechanism of injury should be made to avoid missing pronation–external rotation injuries that often have associated ligamentous injury (Weber C fractures). Such fractures may be unstable, and prompt orthopedic referral should be made if they are suspected.